From: Stan Rasmussen
To: Utah House of Representatives, Utah Senate,
Subject: MEDICAID EXPANSION UPDATE #3: Procedurally and substantially, the Healthy Utah Plan is an expansion of Medicaid
Date: Thu Apr 24 20:39:20 MDT 2014

Dear Senator/Representative,


In order to have a candid and truly robust dialogue about the proposed Healthy Utah Plan, we must agree to some of the basic facts about the proposal. For instance, some have claimed that the Healthy Utah Plan does not expand Utah’s Medicaid program. This is a factually incorrect statement, for both procedural and substantial policy reasons.


Procedurally, in order for the state to implement the waiver required for the Healthy Utah Plan, it must first accept Medicaid expansion under the provisions of Obamacare, which makes that waiver both necessary and possible in the first place. Describing the Medicaid expansion procedure for Arkansas, which obtained a waiver to use Medicaid expansion funds to subsidize private insurance coverage for the expansion population, legal expert Robert Alt (for his bio, click here) stated:


“It’s useful to remember that the so-called Arkansas Plan begins with a state opting in to Medicaid expansion, and then they converted to a premium support model.... [Y]ou have to opt in to Medicaid participation and the match rates in order to go ahead and do the conversion to the premium support model. I think that’s useful for folks to consider because often times I think there’s an attempt to confuse individuals; to try and use that to say, ‘No, no, no. This isn’t Medicaid,’ when, in fact, it is Medicaid expansion. It’s just Medicaid expansion with another layer added on top.”


In other words, the procedure for Utah’s waiver would require the state to opt into Medicaid expansion. Then the state would be able to implement, under the terms of its federally-approved waiver, the state’s preferred version of Medicaid expansion: the Healthy Utah Plan. After all, why would the State of Utah need a waiver from a program (i.e., Medicaid expansion) it has not opted into?


The proposed Healthy Utah Plan is also an expansion of Medicaid in its policy substance. It would use federal Medicaid expansion funds, which it receives under the authority of the Medicaid expansion provisions of Obamacare, to provide health insurance coverage to the Medicaid expansion population. And once entered into, the proposed Healthy Utah Plan would be governed by the rules and restrictions authorized by federal Medicaid law (e.g., the expansion population becomes a mandatory population in the state’s Medicaid program) and the U.S. Dept. of Health, just like traditional Medicaid. 


While some of the policy particulars are different from traditional Medicaid, the policy substance of the proposed Healthy Utah Plan is to expand Utah’s Medicaid program to include a component which subsidizes private insurance coverage for a portion of the Medicaid population. In essence, it establishes a two-tier Medicaid system: traditional Medicaid for Utah’s most vulnerable residents, and subsidized private insurance coverage for more fortunate Medicaid enrollees.


With a firm grasp on the basic facts of Medicaid expansion, Utahns will be the beneficiaries of a genuine, robust dialogue and debate regarding the proposed Healthy Utah Program. Without such candor it will be difficult, if not impossible, to truly determine whether the Healthy Utah Plan is the right Medicaid and health care policy for Utah.


Derek Monson

Director of Policy

cell: 512-698-1657


Stan Rasmussen

Director of Public Affairs 

cell: 801-718-1841


Sutherland Institute