1
2
3
4
5
6
7
8
9 LONG TITLE
10 General Description:
11 This bill authorizes the extension of primary care network benefits to adults under
12 100% of the federal poverty level and extension of traditional Medicaid benefits to
13 certain adults without a dependent child and certain adults with a dependent child.
14 Highlighted Provisions:
15 This bill:
16 ▸ defines terms;
17 ▸ instructs the Department of Health to apply for a waiver from federal statutory and
18 regulatory law to:
19 • extend coverage under the primary care network to adults below 100% of the
20 federal poverty level;
21 • allow psychiatrists, psychiatric advance practice registered nurses, and other
22 mental health providers with prescribing authority to provide primary care in the
23 primary care network;
24 • extend traditional Medicaid benefits to certain adults without a dependent child;
25 • extend traditional Medicaid benefits to certain adults with a dependent child;
26 and
27 • provide financial sustainability for the waiver by permitting the state to adjust
28 the percentage of poverty level covered, either up or down, based on program
29 costs and the state budget; and
30 ▸ instructs the Department of Health to continue negotiations with the federal
31 government to obtain greater flexibility for any future Medicaid expansion.
32 Money Appropriated in this Bill:
33 This bill appropriates:
34 ▸ for fiscal years 2014-2015 and 2015-2016, ongoing:
35 • funding for the primary care network expansion and the coverage for certain
36 adults in the traditional Medicaid program, including estimated woodwork
37 effect.
38 Other Special Clauses:
39 None
40 Utah Code Sections Affected:
41 AMENDS:
42 26-18-18, as enacted by Laws of Utah 2013, Chapter 477
43 63J-1-602.1, as last amended by Laws of Utah 2014, Chapter 384
44
45 Be it enacted by the Legislature of the state of Utah:
46 Section 1. Section 26-18-18 is amended to read:
47 26-18-18. Optional Medicaid expansion.
48 (1) For purposes of this section:
49 (a) "Adult expansion population" means individuals who:
50 (i) are described in 42 U.S.C. Sec. 1396a(10)(A)(i)(VIII); and
51 (ii) are not otherwise eligible for Medicaid as mandatory categorically needy
52 individuals.
53 (b) "PPACA" [
54 (2) The department and the governor shall not expand the state's Medicaid program to
55 the [
56 [
57
58 [
59 [
60
61 [
62 [
63
64
65 (a) the department implements a program for the adult expansion population in
66 accordance with Subsections (3) and (4); or
67 [
68 for expansion of the Medicaid program for [
69 Legislature under the high impact federal funds request process required by Section 63J-5-204,
70 Legislative review and approval of certain federal funds request.
71 (3) The department shall amend the state Medicaid plan and obtain from the Centers
72 for Medicare and Medicaid Services within the United States Department of Health and
73 Human Services waivers from federal statutory and regulatory law necessary to implement a
74 plan to extend Medicaid services to an individual in the adult expansion population, within
75 appropriations from the Legislature:
76 (a) if the individual is:
77 (i) an adult without a dependent child who is at or below a percentage of the federal
78 poverty level:
79 (A) that is designated by the department;
80 (B) which may not exceed 33% of the federal poverty level; and
81 (C) that is specifically funded for this program in the fiscal year; or
82 (ii) an adult who has a dependent child and who is at or below a percentage of the
83 federal poverty level:
84 (A) that is designated by the department;
85 (B) which may not exceed 64% of the federal poverty level; and
86 (C) that is specifically funded for this program in the fiscal year; and
87 (b) if the Medicaid program is permitted to adjust the percentage of the federal poverty
88 level designated under Subsection (3)(a)(i) or (ii), either up or down, as necessary to respond to
89 the adult expansion population program costs and the state budget.
90 (4) (a) The department shall request a waiver from the Centers for Medicare and
91 Medicaid Services within the United States Department of Health and Human Services from
92 federal statutory and regulatory law necessary to amend the state Medicaid plan to continue the
93 state's primary care network for adults who:
94 (i) are not covered under Subsection (3)(a);
95 (ii) are below 95% of the federal poverty level after applying the mandatory 5%
96 disregard; and
97 (iii) can be covered in the primary care network within appropriations from the
98 Legislature.
99 (b) The department shall seek waivers if necessary, and shall include the following in
100 the primary care network:
101 (i) coverage for certain anti-psychotics, injectable anti-psychotics, and mood
102 stabilizers; and
103 (ii) use of psychiatrists, psychiatric advance practice registered nurses, and other
104 mental health providers who have prescriptive authority for primary care services covered by
105 the program.
106 (5) (a) If the department obtains waivers under Subsection (3), the department shall
107 amend the state Medicaid plan and implement the Medicaid program in accordance with the
108 waivers under Subsection (3).
109 (b) If the department obtains waivers under Subsections (3) and (4), the department
110 shall amend the state Medicaid plan and implement the Medicaid program in accordance with
111 the waivers under Subsections (3) and (4).
112 (6) The department shall:
113 (a) continue to negotiate with the Centers for Medicare and Medicaid Services for
114 additional waivers from federal statutory and regulatory law necessary to implement a plan
115 with additional state flexibility and increased federal match rates;
116 (b) comply with the reporting and the legislative approval process required by
117 Subsection (2)(b) before expanding Medicaid to any portion of the adult expansion population
118 that differs from the provisions of Subsections (3) and (4); and
119 (c) annually report to the Legislature's Health Reform Task Force, on or before
120 November interim day, regarding the enrollment in the Medicaid program, the primary care
121 network program and costs to the state for each of the programs.
122 Section 2. Section 63J-1-602.1 is amended to read:
123 63J-1-602.1. List of nonlapsing accounts and funds -- General authority and Title
124 1 through Title 30.
125 (1) Appropriations made to the Legislature and its committees.
126 (2) The Percent-for-Art Program created in Section 9-6-404.
127 (3) The Martin Luther King, Jr. Civil Rights Support Restricted Account created in
128 Section 9-18-102.
129 (4) The LeRay McAllister Critical Land Conservation Program created in Section
130 11-38-301.
131 (5) An appropriation made to the Division of Wildlife Resources for the appraisal and
132 purchase of lands under the Pelican Management Act, as provided in Section 23-21a-6.
133 (6) Award money under the State Asset Forfeiture Grant Program, as provided under
134 Section 24-4-117.
135 (7) Funds collected from the emergency medical services grant program, as provided in
136 Section 26-8a-207.
137 (8) The Prostate Cancer Support Restricted Account created in Section 26-21a-303.
138 (9) State funds appropriated for matching federal funds in the Children's Health
139 Insurance Program as provided in Section 26-40-108.
140 (10) The Utah Health Care Workforce Financial Assistance Program created in Section
141 26-46-102.
142 (11) The primary care grant program created in Section 26-10b-102.
143 (12) All appropriations associated with the adult expansion population in the Medicaid
144 program created in Section 26-18-18.
145 Section 3. Appropriation.
146 Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, for
147 the fiscal year beginning July 1, 2014 and ending June 30, 2015, the following sums of money
148 are appropriated from resources not otherwise appropriated, or reduced from amounts
149 previously appropriated, out of the funds or accounts indicated. These sums of money are in
150 addition to any amounts previously appropriated for fiscal year 2015.
151 To Department of Health - Medicaid and Health Financing
152 From General Fund, One-time
$143,000
153 From Federal Funds
$578,000
154 Schedule of Programs:
155 Director's Office $721,000
156 Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, for
157 the fiscal year beginning July 1, 2015 and ending June 30, 2016, the following sums of money
158 are appropriated from resources not otherwise appropriated, or reduced from amounts
159 previously appropriated, out of the funds or accounts indicated. These are additions to any
160 amounts previously appropriated for fiscal year 2016.
161 To Department of Human Services - Substance Abuse and Mental Health
162 From General Fund
($2,000,000)
163 Schedule of Programs:
164 Mental Health Centers ($78,600)
165 Local Substance Abuse Services ($1,921,400)
166 To Department of Health - Medicaid and Health Financing
167 From General Fund
$323,000
168 From Federal Funds
$480,500
169 Schedule of Programs:
170 Director's Office $803,500
171 To Department of Health - Medicaid Optional Services
172 From General Fund
$23,000,000
173 From Federal Funds
$53,000,000
174 Schedule of Programs:
175 Other Optional Services $76,000,000
176 To Utah Department of Corrections - Department of Medical Services
177 From General Fund
($1,000,000)
178 Schedule of Programs:
179 Medical Services ($1,000,000)
180 To Department of Workforce Services - Operations and Policy
181 From General Fund
$1,633,200
182 From General Fund, One-time
$15,200
183 From Federal Funds
$1,770,300
184 Schedule of Programs:
185 Eligibility Services $3,266,400
186 Information Technology $152,300
187 To Department of Health - Mandatory Services
188 From General Fund
$10,000,000
189 From General Fund, One-time
$100,000
190 From Federal Funds
$27,900,000
191 Schedule of Programs:
192 Other Mandatory Services $37,000,000
193 Medicaid Management Information
194 Systems Replacement $1,000,000