Chief Sponsor: Allen M. Christensen

House Sponsor: ____________


8     General Description:
9          This bill amends the Medical Assistance Act within the Utah Health Code.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     extends access to health care to individuals not currently eligible for Medicaid who
14     are:
15               •     below 100% of the federal poverty level;
16               •     medically frail;
17               •     uninsured; and
18               •     vulnerable to becoming disabled; and
19          ▸     instructs the Utah Department of Health to obtain from the Centers for Medicare
20     and Medicaid Services within the United States Department of Health and Human
21     Services waivers from federal law necessary to implement the coverage for the
22     medically frail.
23     Money Appropriated in this Bill:
24          None
25     Other Special Clauses:
26          None
27     Utah Code Sections Affected:

28     AMENDS:
29          26-18-18, as enacted by Laws of Utah 2013, Chapter 477

31     Be it enacted by the Legislature of the state of Utah:
32          Section 1. Section 26-18-18 is amended to read:
33          26-18-18. Optional Medicaid expansion.
34          (1) For purposes of this section:
35          (a) "CMS" means the Centers for Medicare and Medicaid Services within the United
36     States Department of Health and Human Services.
37          (b) "Medically frail" means an individual who is:
38          (i) medically exempt under 42 C.F.R. 440.315;
39          (ii) in the optional expansion population;
40          (iii) below 100% of the federal poverty level;
41          (iv) uninsured; and
42          (v) likely to become disabled without access to health care.
43          (c) "Optional expansion population" means the newly eligible adult group authorized
44     under PPACA.
45          (d) "PPACA" [is as] means the same as that term is defined in Section 31A-1-301.
46          (2) The department and the governor shall not expand the state's Medicaid program to
47     the optional expansion population under PPACA unless[:] the department obtains a waiver in
48     accordance with Subsection (3).
49          [(a) the Health Reform Task Force has completed a thorough analysis of a statewide
50     charity care system;]
51          [(b) the department and its contractors have:]
52          [(i) completed a thorough analysis of the impact to the state of expanding the state's
53     Medicaid program to optional populations under PPACA; and]
54          [(ii) made the analysis conducted under Subsection (2)(b)(i) available to the public;]
55          [(c) the governor or the governor's designee has reported the intention to expand the
56     state Medicaid program under PPACA to the Legislature in compliance with the legislative
57     review process in Sections 63M-1-2505.5 and 26-18-3; and]
58          [(d) notwithstanding Subsection 63J-5-103(2), the governor submits the request for

59     expansion of the Medicaid program for optional populations to the Legislature under the high
60     impact federal funds request process required by Section 63J-5-204, Legislative review and
61     approval of certain federal funds request.]
62          (3) The department shall amend the state Medicaid plan and obtain from CMS waivers
63     from federal statutory and regulatory law necessary to establish a five year pilot program to:
64          (a) provide access to care for a segment of the uninsured population in the state who
65     are vulnerable to becoming disabled due to their medical frailty;
66          (b) establish a screening process for identifying the medically frail;
67          (c) provide a medically frail individual who is offered employer sponsored health
68     insurance the option to enroll in the employer sponsored coverage, as provided in Section 1906
69     of the Social Security Act;
70          (d) improve health and behavioral outcomes of the demonstration participants; and
71          (e) serve as a bridge to closing the coverage gap in Utah.
72          (4) The waiver obtained under Subsection (3) may not include a maintenance of effort
73     requirement for the state's coverage of the medically frail.
74          (5) The department shall adopt administrative rules to:
75          (a) implement coverage of the medically frail in accordance with this section; and
76          (b) establish criteria to evaluate enrollees who are medically frail.

Legislative Review Note
     as of 1-14-15 11:13 AM

Office of Legislative Research and General Counsel