CMS’ decision to approve the work requirements suggests the Trump administration has no plans to halt its efforts to reshape Medicaid, despite legal challenges that have prompted a growing number of states to pause their efforts to implement Medicaid work requirements.
Under the ACA, states expanding their Medicaid programs must offer coverage to individuals with annual incomes up to 138% of the federal poverty line (FPL). The federal government currently covers at least 90% of the cost of expanding Medicaid to individuals with incomes up to 138% FPL.
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Last year, 53% of Utah voters approved Proposition 3, which directed the state to expand Medicaid coverage to individuals with annual incomes up to 138% FPL and implement a 0.15% sales tax on nonfood items to cover the state’s cost of the expansion.
However, Republican lawmakers in the state raised concerns that the ballot initiative’s sales tax would not generate sufficient funds to cover the state’s expansion costs and introduced a bill to allow Utah to seek federal permission to scale back the expansion.
The bill was approved, and state officials submitted a Medicaid waiver request to CMS seeking a partial Medicaid expansion, as well as other changes to the state’s Medicaid program. CMS approved that request with a federal match of 70% of the cost of Medicaid expansion, as opposed to the 90% matching rate of a full-scale expansion.
In response, Utah in November 2019 submitted an updated request to CMS for a full Medicaid expansion under the ACA.
CMS OKs Medicaid expansion with work requirements
The approved waiver allows Utah to expand the state’s Medicaid program to adults with annual incomes up to 138% FPL, which is equivalent to $16,753 for an individual and $34,638 for a family of four, according to the Deseret News. The expanded Medicaid program took effect on Jan. 1, 2020. An estimated 120,000 state residents are eligible for Medicaid coverage under the expanded program, according to the News.
The waiver requires beneficiaries who are covered under the Medicaid expansion to complete an online job assessment, online training programs, and 48 job searches within the first three months of their enrollment in the program. If affected beneficiaries do not meet those requirements, the state will end their coverage, the News reports. State officials have projected an estimated 6,000 to 8,000 Medicaid beneficiaries will not comply with the requirements.
The waiver exempts from the work requirements beneficiaries who care for young children, are older than 60, are pregnant, work at least 30 hours per week, and some others. State officials have estimated 70% of Medicaid beneficiaries will be exempt from the work requirements.
The state under the approved waiver requires Medicaid beneficiaries to enroll in employer-sponsored health insurance if they are eligible. Under the waiver, the state’s Medicaid program covers premium and other out-of-pocket costs for beneficiaries who enroll in employer-sponsored health plans.
Utah’s approved waiver allows the state to provide dental benefits to beneficiaries ages 65 and older and coverage for dental crowns to beneficiaries who are elderly, as well as those who are undergoing substance use disorder treatment.
CMS did not approve Utah’s request to allow the state to charge premiums to adults Medicaid beneficiaries with annual incomes above 100% FPL, lock beneficiaries out of Medicaid coverage for intentional program violations, require a $10 surcharge for each visit to an ED for non-acute problems, or provide housing supports to certain beneficiaries. CMS is separately considering whether to approve those outstanding requests, the Associated Press reports.