Utah’s partial Medicaid expansion

Utah has expanded Medicaid to anyone earning at or under 100% Federal Poverty Level (FPL):

The Centers for Medicare and Medicaid Services (CMS) today authorized the Utah Department of Health (UDOH) to expand its Medicaid program to approximately 70,000-90,000 Utah adults. The newly eligible individuals can begin applying for coverage on Monday, April 1.

Under the newly approved plan, Utah residents who earn up to 100% of the federal poverty level, about $12,492 for an individual or $25,752 for a family of four, will be eligible to receive full Medicaid benefits. The federal government will cover approximately 70% of the cost (emphasis mine) of the new program; the State of Utah will cover the remaining 30%.

Utah is spending more money to cover fewer pepole with a partial expansion. Right now they have received a waiver to expand to new voluntary populations at the current standard federal match rate. If the legislature had expanded Medicaid to 138% FPL the federal government would have paid 90% of the costs.

Yet, this is an improvement on coverage in the state of Utah as adults who earn between 100-138% FPL are being made no worse off as they still don’t have access to Medicaid unless there is a significant medical qualifying status but they still have access to premium tax credits and CSR-94 Silver plans.

Sometime over the summer, Utah will be asking for a second waiver from CMS. That waiver will ask for the Federal government to pay the enhanced ACA 90% match for only people earning under 100% FPL. The 100-138% cohort would remain on the exchanges.

There are some complex interactions with subsidies, differential morbidity and silver loading which can lead to some fascinatingly unusual results on a distributional basis if there is a partial expansion to only 100% FPL. But at the base, tens of thousands of people will have health insurance starting next week.