7 LONG TITLE
8 General Description:
9 This bill establishes the Access Utah program to provide access to health care to certain
10 individuals below the federal poverty level.
11 Highlighted Provisions:
12 This bill:
13 . updates language regarding the prohibition against Medicaid expansion to reflect
14 current federal regulations;
15 . creates a two-year pilot program known as Access Utah to provide a defined
16 contribution health benefit to individuals who are below the federal poverty level
17 and who meet other need based requirements;
18 . establishes a coordinated care model for providing care in Access Utah; and
19 . instructs the Department of Health to:
20 * work with the Legislature's Health Reform Task Force to develop a
21 Section 1332 Medicaid waiver; and
22 * submit an amendment of the Utah Premium Partnership and Primary Care
23 Network waiver to the Centers for Medicare and Medicaid Services to
24 incorporate the Access Utah program.
25 Money Appropriated in this Bill:
27 Other Special Clauses:
29 Utah Code Sections Affected:
31 26-18-18 , as enacted by Laws of Utah 2013, Chapter 477
33 26-18-20 , Utah Code Annotated 1953
35 Be it enacted by the Legislature of the state of Utah:
36 Section 1. Section 26-18-18 is amended to read:
37 26-18-18. Optional Medicaid expansion.
38 (1) For purposes of this section:
39 (a) "Optional expansion population" means individuals who:
40 (i) do not qualify for the state's Medicaid program; and
41 (ii) the Centers for Medicare and Medicaid Services within the United States
42 Department of Health and Human Services would otherwise determine are eligible for funding
43 at the enhanced federal medical assistance percentage available under PPACA beginning
44 January 1, 2014.
45 (b) PPACA is as defined in Section 31A-1-301 .
46 (2) The department and the governor shall not expand the [
47 the optional expansion population under PPACA unless:
55 the state Medicaid program under PPACA to the Legislature in compliance with the legislative
56 review process in Sections 63M-1-2505.5 and 26-18-3 ; and
58 for expansion of the Medicaid program for optional populations to the Legislature under the
59 high impact federal funds request process required by Section 63J-5-204 , Legislative review
60 and approval of certain federal funds request.
61 Section 2. Section 26-18-20 is enacted to read:
62 26-18-20. Access Utah -- Eligibility -- Defined contribution.
63 (1) For purposes of this section:
64 (a) "Access Utah" means the defined contribution program created in this section.
65 (b) "Medically frail" means an individual who meets the criteria of 42 C.F.R. 440.315
66 as determined by the department based on methodology administered by the department or
67 another entity selected by the department.
68 (c) "Optional expansion population" is as defined in Section 26-18-18 .
69 (2) (a) The department shall establish a two-year pilot program known as "Access
70 Utah," which shall:
71 (i) begin on January 1, 2015, and end on January 1, 2017; and
72 (ii) provide a defined contribution to eligible individuals in accordance with this
74 (b) The department shall work with the Legislature's Health Reform Task Force to
75 develop a Medicaid waiver proposal under Section 1332 of the Social Security Act to submit to
76 the Centers for Medicare and Medicaid Services within the United States Department of Health
77 and Human Services.
78 (3) An individual is eligible for Access Utah if the individual:
79 (a) (i) is in the optional expansion population and below 100% of the federal poverty
80 level; and
81 (ii) (A) is medically frail; or
82 (B) is an adult with a dependent child; and
83 (b) if funding permits, is an individual described in Subsection (3)(a)(i), but not in
84 Subsection (3)(a)(ii).
85 (4) (a) Within appropriations from the Legislature, the department shall offer to an
86 eligible individual a defined contribution in an amount determined by the department.
87 (b) An eligible individual shall use the defined contribution to purchase employer
88 sponsored health insurance coverage if the individual is offered employer sponsored health
89 insurance coverage.
90 (c) If an eligible individual is not offered employer sponsored coverage, the individual
91 may use the defined contribution to purchase:
92 (i) a commercial health insurance policy; or
93 (ii) access to a coordinated care model described in Subsection (5).
94 (5) (a) The department may contract with public and private entities to provide or
95 manage the delivery of a coordinated care model to an individual described in Subsection
97 (b) The coordinated care model shall combine state and federal funding with charity
98 care resources to:
99 (i) provide, as funding permits, preventive care, outpatient care, pharmacy benefits,
100 urgent and emergency care, and limited hospital benefits; and
101 (ii) integrate physical health and behavioral health services.
102 (6) The department shall evaluate and report to the Legislature's Health Reform Task
103 Force on or before November 1, 2016, regarding:
104 (a) the methods used to determine a medically frail individual and the number of
105 medically frail individuals who enrolled in Access Utah;
106 (b) access to and quality of care in Access Utah; and
107 (c) whether Access Utah helped to facilitate enrollee self-sufficiency.
108 (7) (a) Notwithstanding Section 26-18-18 , the department shall seek an extension of
109 Utah's Primary Care Network and the Utah Premium Partnership 1115 Waiver from the
110 Centers for Medicare and Medicaid Services within the United States Department of Health
111 and Human Services in accordance with Subsection (7)(b).
112 (b) The department may modify the Primary Care Network and The Utah Premium
113 Partnership scope of benefits and eligibility criteria as part of the waiver request under
114 Subsection (7)(a) if:
115 (i) the department develops the waiver request in coordination with the Legislature's
116 Health Reform Task Force and reports to the Legislature's Executive Appropriations
117 Committee regarding the waiver request; and
118 (ii) the modification of benefits will:
119 (A) not increase the state's expenditure for the Access Utah program beyond the
120 Legislature's appropriation for the program; and
121 (B) further the state's goal to reduce health care costs, improve access to health care,
122 and improve health outcomes of Utah citizens.
Legislative Review Note
as of 2-24-14 11:01 AM