Note: A list of others present, a copy of related materials, and an audio recording of the meeting can be found at www.le.utah.gov.

1. Task Force Business

Chair Dunnigan called the meeting to order at 9:23 a.m. Rep. Poulson was excused from the meeting.

MOTION: Rep. Gibson moved to approve the minutes of the August 28, 2014, meeting. The motion passed unanimously.

2. Insurance and the Criminal Justice System

Mr. Patrick Fleming, Director of Mental Health, Salt Lake County Behavioral Health Services, introduced the members of the panel.

Mr. Dave Walsh, Deputy Director, Commission on Criminal and Juvenile Justice (CCJJ), distributed “Utah Justice Reinvestment Initiative in Partnership with the Pew Charitable Trusts.” Task force staff distributed a copy of slides by the same title used by Mr. Walsh and subsequent presenters under this agenda item. Mr. Walsh reviewed findings from a Pew Charitable Trusts study of Utah’s corrections system, policy options under consideration by CCJJ’s Treatment and Supervision Subcommittee, and the prevalence of substance use and mental health disorders among the U.S. corrections population. Mr. Walsh reported that CCJJ hopes to release a report on the Pew study in November along with final recommendations, including legislation for consideration during the 2015 General Session of the Legislature.

Mr. Dan Becker, State Board Administrator, Administrative Office of the Courts, said that because of budget limitations there are less than 1,000 treatment slots available for drug courts. Even existing slots, he reported, are underfunded, resulting in sliding scale charges to participants and the discharge of individuals from treatment before sufficient progress is achieved. He recommended an expansion of treatment capacity for both substance abuse and mental health issues and noted that fully functioning drug and mental health courts could serve twice as many individuals as they now serve. Mr. Becker said that the governor’s proposed Healthy Utah plan would cover the vast majority of individuals eligible for drug court and would help many others. He indicated that Healthy Utah would create additional work for courts, but that courts are willing to take on that work within their existing budget so that the underlying substance use and mental health issues of those who repeatedly come before them are addressed. He said that effective drug courts end up saving time for the courts.

Dr. Richard Garden, Medical Director, Utah Department of Corrections, said that approximately 7,000 individuals are currently incarcerated in the state, of which up to half have a substance use disorder. Dr. Garden responded to questions from the committee by describing the diagnosis and treatment options offered to the mentally ill within the state prison system. He reported that individuals residing in a government corrections facility or housing area are not eligible for Medicaid.

Mr. Adam Trupp, Chief Executive Officer, Utah Association of Counties, said the Pew study points out that reducing the need for incarceration depends on more than simply expanding insurance coverage. It also depends on addressing housing, care management, and compliance with court orders. He emphasized that coverage for substance use and mental health issues is needed, but that the other needs of individuals must be addressed as well.

Mr. Trupp said that treatment by jails for substance use mental health issues varies in quality and scope across the state.

Mr. Doug Thomas, Director, Division of Substance Abuse and Mental Health, Department of Human Services, said he believes behavioral health is essential to health, prevention works, and treatment is effective. He said that he would let the task force know what percentage of participants in the public system for treating substance disorders have household incomes less than 100% of the federal poverty guidelines. He also said that he would let the task force know what percentage of individuals with household incomes less than 100% of the federal poverty guidelines would qualify for treatment of substance use or mental illness disorders under the governor’s proposed Healthy Utah plan. He said that not all individuals who have a substance use or mental illness disorder would be considered “medically frail” and thus eligible for traditional Medicaid under the governor’s proposed Healthy Utah plan. Mr. Thomas reported that Salt Lake County has done a study showing the savings attributable to mobile crisis outreach teams, which divert individuals experiencing a mental health crisis from hospital emergency departments.

3. Medicaid Expansion — Update on Healthy Utah Plan

Dr. David Patton, Executive Director, Utah Department of Health, updated the task force on the progress of negotiations with the U.S. Department of Health and Human Services regarding the governor’s Healthy Utah plan. He said that the main obstacle in negotiations with the federal government has been the work requirement, but that the parties involved have agreed to a “work effort” program, which will offer enrollees training and support to obtain or improve employment. In response to questions from the committee, Dr. Patton said that this employment assistance already exists, but registration for Healthy Utah will automatically register Healthy Utah applicants for it.

Mr. Nate Checketts, Health Reform Coordinator, Utah Department of Health, described the employment assessment, training videos, and job availability notification associated with the work effort requirement proposed by Healthy Utah. Mr. Checketts discussed the opportunity for employment assistance for underemployed individuals as well as unemployed individuals. He said that under Healthy Utah, there will be two plans: one with a higher premium and a lower copay for nonemergent use of a hospital emergency department, and one with a lower premium and a higher copay for nonemergent use of a hospital emergency department. He said he believes that Utah will be the first state in the nation to use this two-plan option allowed under federal law.

Mr. Kevin Burt, Associate Director of Programs and Training, Department of Workforce Services, said the Temporary Assistance for Needy Families program (TANF) requires 50% of participants to meet a 30‑hour per week employment participation requirement. He added that very few states, including Utah, meet the 50% requirement. He said TANF participants who do not meet negotiated employment requirements are terminated from the program. He said he would provide the task force with the number of individuals who have been terminated. Mr. Burt also reviewed activities that count toward the 30-hour requirement, including vocational education, resume writing, and providing child care services for someone else who is employed.

4. Addressing the “Coverage Gap”

Mr. Checketts said that Arkansas’ estimate that 11% of the “coverage gap” population is “medically frail” and a national estimate that 30% of the “coverage gap” population has a substance use disorder or mental illness are the best estimates available. He said that because every state runs its Medicaid program differently than others, he doesn’t believe the federal government tracks whether enrollees are “medically frail.” Mr. Checketts reviewed the federal Medicaid definition of “medically frail” and said that under Healthy Utah, the medically frail will have the option to enroll in either Healthy Utah or traditional Medicaid. Mr. Checketts said that he would provide the task force with an estimate of the number of adults who meet all three of the following conditions: have children, have a household income under 100% of the federal poverty guidelines, and are not otherwise eligible for Medicaid.

5. Health Insurance Plan Rates — 2015

Commissioner Todd Kiser, Utah Insurance Department, said that rate reviews for 2015 health insurance plans are nearing completion. He said the commission reviewed 400 plans last year and 900 plans this year. He said 2015 plan rates are expected to increase by 3.5% in the small group market and 5.7% in the individual market. He noted for comparison that PricewaterhouseCoopers has estimated that rates in the individual market nationwide are expected to increase 7%. He also said that rates for the second lowest cost silver plans in the individual market are expected to increase, so enrollees should shop for a 2015 plan and not simply let their policies renew automatically.

Ms. Tanji Northrup, Assistant Commissioner, Utah Insurance Department, presented “2015 Individual and Small Employer Markets.” She said the 2015 rate review process has not been finalized, so rates are subject to change. She discussed the 2015 dental and major medical plans to be offered in each of the two health insurance exchanges in the state and rates for individual market plans in Salt Lake County, both inside and outside the federal exchange. Ms. Northrup also said that the Insurance Department is encouraging individuals in the federal exchange to review their plans and not simply allow them to renew automatically.

Ms. Northrup explained why there are so many more plans in the exchanges this year than last. She also pointed out that after the reinsurance and risk corridor programs under the federal Affordable Care Act expire at the end of 2016, rates in the individual market will once again be higher than rates in the small group market.

6. Federal Regulations Update

Ms. Dupont indicated there have been no new federal Affordable Care Act regulations of interest to the task force.

7. Adjourn

MOTION: Sen. Knudson moved to adjourn the meeting. The motion passed unanimously with Rep. Gibson absent for the vote.

Chair Dunnigan adjourned the meeting at 11:33 a.m.