Section 1. Section 26B-1-315 is amended to read:26B-1-315Effective 05/06/26Superseded 07/01/26. Medicaid ACA Fund.(1)There is created an expendable special revenue fund known as the "Medicaid ACA Fund."(2)The fund consists of:(a)assessments collected under Chapter 3, Part 5, Inpatient Hospital Assessment;(b)intergovernmental transfers under Section 26B-3-508;(c)savings attributable to the health coverage improvement program, as defined in Section 26B-3-501, as determined by the department;(d)savings attributable to the enhancement waiver program, as defined in Section 26B-3-501, as determined by the department;(e)savings attributable to the Medicaid waiver expansion, as defined in Section 26B-3-501, as determined by the department;(f)revenues collected from the sales tax described in Subsection 59-12-103(11);(g)gifts, grants, donations, or any other conveyance of money that may be made to the fund from private sources;(h)interest earned on money in the fund as described in Subsection (3)(d); and(i)additional amounts as appropriated by the Legislature.(3)(a)The fund shall earn interest.(b)AllBeginning July 1, 2026, up to $7,000,000 of the interest earned on fund money shall be deposited annually into the fundDivision of Services for People with Disabilities Restricted Account created in Section 26B-1-335.(c)Beginning July 1, 2026, except as provided in Subsection (3)(d), remaining interest earned on fund money after the deposit described in Subsection (3)(b) shall be deposited annually into the Medicaid Growth Reduction and Budget Stabilization Account created in Section 63J-1-315.(d)In any year in which the principal in the Medicaid ACA Fund falls below the five-year expenditure value at risk as determined by the Office of the Legislative Fiscal Analyst and approved by the Executive Appropriations Committee, the amount described in Subsection (3)(c) shall be deposited into the Medicaid ACA Fund.(4)(a)A state agency administering the provisions of Chapter 3, Part 5, Inpatient Hospital Assessment, may use money from the fund to pay the costs, not otherwise paid for with federal funds or other revenue sources, of:(i)the health coverage improvement program as defined in Section 26B-3-501;(ii)the enhancement waiver program as defined in Section 26B-3-501;(iii)a Medicaid waiver expansion as defined in Section 26B-3-501; and(iv)the outpatient upper payment limit supplemental payments under Section 26B-3-511.(b)A state agency administering the provisions of Chapter 3, Part 5, Inpatient Hospital Assessment, may not use:(i)funds described in Subsection (2)(b) to pay the cost of private outpatient upper payment limit supplemental payments; or(ii)money in the fund for any purpose not described in Subsection (4)(a).

Section 2. Section 26B-1-315 is amended to read:26B-1-315Effective 07/01/26Repealed 07/01/34. Medicaid ACA Fund.(1)There is created an expendable special revenue fund known as the "Medicaid ACA Fund."(2)The fund consists of:(a)assessments collected under Chapter 3, Part 5, Inpatient Hospital Assessment;(b)intergovernmental transfers under Section 26B-3-508;(c)savings attributable to the health coverage improvement program, as defined in Section 26B-3-501, as determined by the department;(d)savings attributable to the enhancement waiver program, as defined in Section 26B-3-501, as determined by the department;(e)savings attributable to the Medicaid waiver expansion, as defined in Section 26B-3-501, as determined by the department;(f)revenues collected from the sales tax described in Subsection 59-12-103(6);(g)gifts, grants, donations, or any other conveyance of money that may be made to the fund from private sources;(h)interest earned on money in the fund as described in Subsection (3)(d); and(i)additional amounts as appropriated by the Legislature.(3)(a)The fund shall earn interest.(b)AllBeginning July 1, 2026, up to $7,000,000 of the interest earned on fund money shall be deposited annually into the fundDivision of Services for People with Disabilities Restricted Account created in Section 26B-1-335.(c)Beginning July 1, 2026, except as provided in Subsection (3)(d), remaining interest earned on fund money after the deposit described in Subsection (3)(b) shall be deposited annually into the Medicaid Growth Reduction and Budget Stabilization Account created in Section 63J-1-315.(d)In any fiscal year in which the principal in the Medicaid ACA Fund falls below the five-year expenditure value at risk as determined by the Office of the Legislative Fiscal Analyst and approved by the Executive Appropriations Committee, the amount described in Subsection (3)(c) shall be deposited into the Medicaid ACA Fund.(4)(a)A state agency administering the provisions of Chapter 3, Part 5, Inpatient Hospital Assessment, may use money from the fund to pay the costs, not otherwise paid for with federal funds or other revenue sources, of:(i)the health coverage improvement program as defined in Section 26B-3-501;(ii)the enhancement waiver program as defined in Section 26B-3-501;(iii)a Medicaid waiver expansion as defined in Section 26B-3-501; and(iv)the outpatient upper payment limit supplemental payments under Section 26B-3-511.(b)A state agency administering the provisions of Chapter 3, Part 5, Inpatient Hospital Assessment, may not use:(i)funds described in Subsection (2)(b) to pay the cost of private outpatient upper payment limit supplemental payments; or(ii)money in the fund for any purpose not described in Subsection (4)(a).

Section 3. Section 26B-1-335 is amended to read:26B-1-335Effective 05/06/26. Division of Services for People with Disabilities Restricted Account.(1)As used in this section, "account" means the Division of Services for People with Disabilities Restricted Account created in Subsection (2).(2)There is created a restricted account within the General Fund known as the "Division of Services for People with Disabilities Restricted Account."(3)The account consists of:(a)carry forward funds from the division's budget; and(b)unexpended balances lapsed to the account from the division's budget.; and(c)funds deposited into the account from the Medicaid ACA Fund in accordance with Subsection 26B-1-315(3)(b).(4)At the close of a fiscal year, the division may, without an appropriation, deposit into the account carry forward funds described in Subsection (3).(5)Subject to appropriation, the Department of Health and Human Services: (a)may expend funds from the account to serve individuals eligible for division services statewide.; and(b)shall expend funds deposited into the account as described in Subsection (3)(c) to serve individuals who are eligible for services from the division and who would otherwise remain on the division's waitlist for services.

Section 4. Section 63J-1-315 is amended to read:63J-1-315Effective 05/06/26. Medicaid Growth Reduction and Budget Stabilization Account -- Transfers of Medicaid growth savings -- Base budget adjustments.(1)As used in this section:(a)"Department" means the Department of Health and Human Services created in Section 26B-1-201.(b)"Division" means the Division of Integrated Healthcare created in Section 26B-3-102.(c)"General Fund revenue surplus" means a situation where actual General Fund revenues collected in a completed fiscal year exceed the estimated revenues for the General Fund for that fiscal year that were adopted by the Executive Appropriations Committee of the Legislature.(d)"Medicaid growth savings" means the Medicaid growth target minus Medicaid program expenditures, if Medicaid program expenditures are less than the Medicaid growth target.(e)"Medicaid growth target" means Medicaid program expenditures for the previous year multiplied by 1.08.(f)"Medicaid program" is as defined in Section 26B-3-101.(g)"Medicaid program expenditures" means total state revenue expended for the Medicaid program from the General Fund, including restricted accounts within the General Fund, during a fiscal year.(h)"Medicaid program expenditures for the previous year" means total state revenue expended for the Medicaid program from the General Fund, including restricted accounts within the General Fund, during the fiscal year immediately preceding a fiscal year for which Medicaid program expenditures are calculated.(i)"Operating deficit" means that, at the end of the fiscal year, the unassigned fund balance in the General Fund is less than zero.(j)"State revenue" means revenue other than federal revenue.(k)"State revenue expended for the Medicaid program" includes money transferred or appropriated to the Medicaid Growth Reduction and Budget Stabilization Account only to the extent the money is appropriated for the Medicaid program by the Legislature.(2)There is created within the General Fund a restricted account to be known as the Medicaid Growth Reduction and Budget Stabilization Account.(3)(a)The following shall be deposited into the Medicaid Growth Reduction and Budget Stabilization Account:(i)deposits described in Subsection (4);(ii)beginning July 1, 2024, any general funds appropriated to the department for the state plan for medical assistance or for Medicaid administration by the Division of Integrated Healthcare that are not expended by the department in the fiscal year for which the general funds were appropriated and which are not otherwise designated as nonlapsing shall lapse into the Medicaid Growth Reduction and Budget Stabilization Account;(iii)beginning July 1, 2024, any unused state funds that are associated with the Medicaid program from the Department of Workforce Services;(iv)beginning July 1, 2024, any penalties imposed and collected under:(A)Section 17B-2a-818.5;(B)Section 19-1-206;(C)Section 63A-5b-607;(D)Section 63C-9-40363O-2-403;(E)Section 72-6-107.5; or(F)Section 79-2-404; and(v)at the close of fiscal year 2024, the Division of Finance shall transfer any existing balance in the Medicaid Restricted Account created in Section 26B-1-309 into the Medicaid Growth Reduction and Budget Stabilization Account.(v)funds deposited into the Medicaid Growth Reduction and Budget Stabilization Account in accordance with Subsection 26B-1-315(3)(c).(b)In addition to the deposits described in Subsection (3)(a), the Legislature may appropriate money into the Medicaid Growth Reduction and Budget Stabilization Account.(4)(a)(i)Except as provided in Subsection (7), if, at the end of a fiscal year, there is a General Fund revenue surplus, the Division of Finance shall transfer an amount equal to Medicaid growth savings from the General Fund to the Medicaid Growth Reduction and Budget Stabilization Account.(ii)If the amount transferred is reduced to prevent an operating deficit, as provided in Subsection (7), the Legislature shall include, to the extent revenue is available, an amount equal to the reduction as an appropriation from the General Fund to the account in the base budget for the second fiscal year following the fiscal year for which the reduction was made.(b)If, at the end of a fiscal year, there is not a General Fund revenue surplus, the Legislature shall include, to the extent revenue is available, an amount equal to Medicaid growth savings as an appropriation from the General Fund to the account in the base budget for the second fiscal year following the fiscal year for which the reduction was made.(c)Subsections (4)(a) and (4)(b) apply only to the fiscal year in which the department implements the proposal developed under Section 26B-3-202 to reduce the long-term growth in state expenditures for the Medicaid program, and to each fiscal year after that year.(5)The Division of Finance shall calculate the amount to be transferred under Subsection (4):(a)before transferring revenue from the General Fund revenue surplus to:(i)the General Fund Budget Reserve Account under Section 63J-1-312;(ii)the Utah Wildfire Fund created in Section 65A-8-217, as described in Section 63J-1-314; and(iii)the State Disaster Recovery Restricted Account under Section 63J-1-314;(b)before earmarking revenue from the General Fund revenue surplus to the Industrial Assistance Account under Section 63N-3-106; and(c)before making any other year-end contingency appropriations, year-end set-asides, or other year-end transfers required by law.(6)(a)If, at the close of any fiscal year, there appears to be insufficient money to pay additional debt service for any bonded debt authorized by the Legislature, the Division of Finance may hold back from any General Fund revenue surplus money sufficient to pay the additional debt service requirements resulting from issuance of bonded debt that was authorized by the Legislature.(b)The Division of Finance may not spend the hold back amount for debt service under Subsection (6)(a) unless and until it is appropriated by the Legislature.(c)If, after calculating the amount for transfer under Subsection (4), the remaining General Fund revenue surplus is insufficient to cover the hold back for debt service required by Subsection (6)(a), the Division of Finance shall reduce the transfer to the Medicaid Growth Reduction and Budget Stabilization Account by the amount necessary to cover the debt service hold back.(d)Notwithstanding Subsections (4) and (5), the Division of Finance shall hold back the General Fund balance for debt service authorized by this Subsection (6) before making any transfers to the Medicaid Growth Reduction and Budget Stabilization Account or any other designation or allocation of General Fund revenue surplus.(7)Notwithstanding Subsections (4) and (5), if, at the end of a fiscal year, the Division of Finance determines that an operating deficit exists and that holding back earmarks to the Industrial Assistance Account under Section 63N-3-106, transfers to the Utah Wildfire Fund and State Disaster Recovery Restricted Account under Section 63J-1-314, transfers to the General Fund Budget Reserve Account under Section 63J-1-312, or earmarks and transfers to more than one of those accounts, in that order, does not eliminate the operating deficit, the Division of Finance may reduce the transfer to the Medicaid Growth Reduction and Budget Stabilization Account by the amount necessary to eliminate the operating deficit.(8)The Legislature may appropriate money from the Medicaid Growth Reduction and Budget Stabilization Account only:(a)for the Medicaid program; and(b)(i)if Medicaid program expenditures for the fiscal year for which the appropriation is made are estimated to be 108% or more of Medicaid program expenditures for the previous year; or(ii)if the amount of the appropriation is equal to or less than the balance in the Medicaid Growth Reduction and Budget Stabilization Account that comprises deposits described in Subsections (3)(a)(ii) through (v) and appropriations described in Subsection (3)(b).(9)The Division of Finance shall deposit interest or other earnings derived from investment of Medicaid Growth Reduction and Budget Stabilization Account money into the General Fund.

Section 5. Effective Date.(1)Except as provided in Subsection (2), this bill takes effect May 6, 2026.(2)The actions affecting Section 26B-1-315 Effective 07/01/26Repealed 07/01/34 take effect on July 1, 2026.