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7 LONG TITLE
8 General Description:
9 This bill authorizes an application for a waiver to the state Medicaid program to expand
10 access to health care to the adult expansion population that does not qualify for the
11 state's traditional Medicaid program.
12 Highlighted Provisions:
13 This bill:
14 ▸ authorizes the Department of Health and the governor to negotiate a waiver to the
15 state Medicaid program to establish a pilot program to provide access to health care
16 to certain individuals in the state;
17 ▸ requires the state Medicaid waiver to meet certain conditions, including notifying
18 enrollees that the expansion is a two year pilot program;
19 ▸ sunsets the Medicaid waiver in two years and requires a legislative review
20 regarding:
21 • the percentage of participants employed, in training, or participating in a work
22 search program;
23 • program enrollment categorized by employer sponsored plans, premium
24 assistance, and medically exempt; and
25 • annual cost per enrollee;
26 ▸ requires approval by the Legislature if the Center for Medicare and Medicaid
27 Services changes the waiver conditions approved by the Legislature in this bill; and
28 ▸ immediately repeals the Medicaid waiver if federal fund participation is reduced
29 below a certain level.
30 Money Appropriated in this Bill:
31 This bill appropriates:
32 ▸ for fiscal years 2016 and 2017:
33 • funds the two year pilot program, including funding more than the estimated
34 woodwork effect and more than the estimated crowd-out effect.
35 Other Special Clauses:
36 None
37 Utah Code Sections Affected:
38 AMENDS:
39 26-18-18, as enacted by Laws of Utah 2013, Chapter 477
40 63I-1-226, as last amended by Laws of Utah 2014, Chapters 25 and 118
41 63J-1-602.1, as last amended by Laws of Utah 2014, Chapter 384
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43 Be it enacted by the Legislature of the state of Utah:
44 Section 1. Section 26-18-18 is amended to read:
45 26-18-18. Optional Medicaid expansion.
46 (1) For purposes of this section:
47 (a) "Adult expansion population" means individuals who:
48 (i) are described in 42 U.S.C. Sec. 1396a(10)(A)(i)(VIII); and
49 (ii) are not otherwise eligible for Medicaid as mandatory categorically needy
50 individuals.
51 (b) "Medically exempt" means an individual who meets the criteria of 42 C.F.R.
52 440.315 as determined by the department based on methodology administered by the
53 department or another entity selected by the department.
54 (c) "PPACA" [
55 (2) The department and the governor shall not expand the state's Medicaid program to
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66 (a) the department implements a program for the adult expansion population in
67 accordance with Subsection (3); or
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69 for expansion of the Medicaid program for [
70 Legislature under the high impact federal funds request process required by Section 63J-5-204,
71 Legislative review and approval of certain federal funds request.
72 (3) The department shall amend the state Medicaid plan and obtain from the Centers
73 for Medicare and Medicaid Services within the United States Department of Health and
74 Human Services waivers from federal statutory and regulatory law necessary to implement a
75 plan to:
76 (a) provide a premium subsidy to an individual who is:
77 (i) in the adult expansion population; and
78 (ii) except as provided in Subsection (3)(g), not medically exempt;
79 (b) for individuals described in Subsection (3)(a), establish a mechanism for an
80 individual to:
81 (i) select a health benefit plan using the premium subsidy offered under Subsection
82 (3)(a); or
83 (ii) if the individual is offered employer sponsored health insurance, enroll in the
84 employer sponsored coverage;
85 (c) seek maximum flexibility for the benefit design of the health benefit plans that an
86 individual described in Subsection (3)(a) may select;
87 (d) seek maximum flexibility for individual responsibility, cost sharing, and wellness
88 programs incorporated into the health benefit plans an individual described in Subsection (3)(a)
89 may select;
90 (e) offer enrollees the option to obtain services to look for and obtain employment;
91 (f) seek flexibility to develop a pilot program to integrate physical and behavioral
92 health services;
93 (g) offer coverage in accordance with 42 C.F.R. 440.315 to an individual who is in the
94 adult expansion population and medically exempt, which shall include the option for the
95 individual to accept a premium subsidy under Subsection (3)(a); and
96 (h) obtain the maximum federal financial participation for the adult expansion
97 population as set forth in 42 U.S.C. Sec. 1396d(y).
98 (4) (a) If the department obtains waivers under Subsection (3):
99 (i) the department may implement the Medicaid program in accordance with the
100 waiver;
101 (ii) the department may implement a transition program to provide coverage to the
102 adult expansion population beginning July 1, 2015 until January 1, 2016;
103 (iii) the department shall notify a person in the adult expansion population who enrolls
104 in the program that the enrollment in the Medicaid program is based on a pilot program; and
105 (iv) in addition to implementing the waiver under Subsection (3), the department may
106 continue to negotiate with the Centers for Medicare and Medicaid Services for additional
107 waivers to the state Medicaid program for the adult expansion population that would establish
108 budgetary protections for the state, such as caps on spending, caps on enrollment, or limitation
109 of benefits available to the adult population.
110 (b) Notwithstanding Subsection (2)(b), if the department obtains additional waivers
111 described in Subsection (4)(a)(iv), the department may implement the waivers without prior
112 authorization under the high impact federal funds request process.
113 (5) If the department does not obtain waivers in accordance with Subsection (3), the
114 department and the governor:
115 (a) may continue negotiations with the Centers for Medicare and Medicaid Services
116 within the United States Department of Health and Human Services regarding waivers from
117 federal statutory and regulatory law; and
118 (b) shall comply with the reporting and the legislative approval process required by
119 Subsection (2)(b)(ii) before expanding Medicaid to any portion of the adult expansion
120 population.
121 (6) On or before July 1, 2017, the department shall report to the Legislature's Health
122 and Human Services Interim Committee regarding:
123 (a) the percentage of participants employed, in training, or participating in a work
124 search program;
125 (b) program enrollment, categorized by employer sponsored plans, premium assistance
126 plans, and the medically exempt; and
127 (c) the annual cost per enrollee.
128 (7) The premium subsidy program and benefits provided to the adult expansion
129 population under this section are repealed on the earlier of:
130 (a) the date of a certification by the executive director that Congress has taken action
131 that will reduce federal financial participation for the adult expansion population below the
132 rates set forth in 42 U.S.C. Sec. 1396d(y) as of January 1, 2014; or
133 (b) the date in Section 63I-1-226.
134 Section 2. Section 63I-1-226 is amended to read:
135 63I-1-226. Repeal dates, Title 26.
136 (1) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
137 1, 2015.
138 (2) Section 26-10-11 is repealed July 1, 2015.
139 (3) Section 26-18-12, Expansion of 340B drug pricing programs, is repealed July 1,
140 2013.
141 (4) Section 26-21-23, Licensing of non-Medicaid nursing care facility beds, is repealed
142 July 1, 2018.
143 (5) Section 26-21-211 is repealed July 1, 2013.
144 (6) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
145 (7) Title 26, Chapter 36a, Hospital Provider Assessment Act, is repealed July 1, 2016.
146 (8) The Medicaid waiver authorized in Subsection 26-18-18(3) is repealed July 1,
147 2017.
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151 2016.
152 Section 3. Section 63J-1-602.1 is amended to read:
153 63J-1-602.1. List of nonlapsing accounts and funds -- General authority and Title
154 1 through Title 30.
155 (1) Appropriations made to the Legislature and its committees.
156 (2) The Percent-for-Art Program created in Section 9-6-404.
157 (3) The Martin Luther King, Jr. Civil Rights Support Restricted Account created in
158 Section 9-18-102.
159 (4) The LeRay McAllister Critical Land Conservation Program created in Section
160 11-38-301.
161 (5) An appropriation made to the Division of Wildlife Resources for the appraisal and
162 purchase of lands under the Pelican Management Act, as provided in Section 23-21a-6.
163 (6) Award money under the State Asset Forfeiture Grant Program, as provided under
164 Section 24-4-117.
165 (7) Funds collected from the emergency medical services grant program, as provided in
166 Section 26-8a-207.
167 (8) The Prostate Cancer Support Restricted Account created in Section 26-21a-303.
168 (9) State funds appropriated for matching federal funds in the Children's Health
169 Insurance Program as provided in Section 26-40-108.
170 (10) The Utah Health Care Workforce Financial Assistance Program created in Section
171 26-46-102.
172 (11) The primary care grant program created in Section 26-10b-102.
173 (12) All appropriations associated with the adult expansion population in the Medicaid
174 program created in Section 26-18-18.
175 Section 4. Appropriation.
176 Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, for
177 the fiscal year beginning July 1, 2014, and ending June 30, 2015, the following sums of money
178 are appropriated from resources not otherwise appropriated, or reduced from amounts
179 previously appropriated, out of the funds or accounts indicated. These sums of money are in
180 addition to any amounts previously appropriated for fiscal year 2015.
181 To Insurance Department - Insurance Department Administration
182 From General Fund Restricted - Insurance Department Account
$5,600
183 Schedule of Programs:
184 Administration $5,600
185 To Department of Health - Medicaid and Health Financing
186 From General Fund, One-time
$793,500
187 From Federal Funds
$1,623,500
188 Schedule of Programs:
189 Director's Office $2,417,000
190 To Department of Workforce Services - Operations and Policy
191 From General Fund, One-time
$140,500
192 From Federal Funds
$1,264,200
193 Schedule of Programs:
194 Information Technology $1,298,800
195 Eligibility Services $105,900
196 Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, for
197 the fiscal year beginning July 1, 2015, and ending June 30, 2016, the following sums of money
198 are appropriated from resources not otherwise appropriated, or reduced from amounts
199 previously appropriated, out of the funds or accounts indicated. These sums of money are in
200 addition to any amounts previously appropriated for fiscal year 2016.
201 To Department of Administrative Services - Inspector General of Medicaid Services
202 From General Fund
$48,800
203 From Federal Funds
$48,700
204 Schedule of Programs:
205 Inspector General of Medicaid Services $97,500
206 To Department of Human Services - Substance Abuse and Mental Health
207 From General Fund
($6,000,000)
208 Schedule of Programs:
209 Mental Health Centers ($235,800)
210 Local Substance Abuse Services ($5,764,200)
211 To Department of Health - Medicaid and Health Financing
212 From General Fund
$658,500
213 From Federal Funds
$778,500
214 Schedule of Programs:
215 Director's Office $1,437,000
216 To Department of Health - Medicaid Optional Services
217 From General Fund
($5,000,000)
218 From General Fund, One-time
$12,000,000
219 From Federal Funds
$342,000,000
220 Schedule of Programs:
221 Other Optional Services $349,000,000
222 To Department of Health - Medicaid Mandatory Services
223 From General Fund, One-time
$33,500,000
224 From Federal Funds
$27,000,000
225 Schedule of Programs:
226 Other Mandatory Services $58,500,000
227 Medicaid Management Information
228 System Replacement $2,000,000
229 To Department of Workforce Services - Operations and Policy
230 From General Fund
$1,590,000
231 From General Fund, One-time
$140,500
232 From Federal Funds
$6,034,200
233 Schedule of Programs:
234 Eligibility Services $6,217,500
235 Information Technology $1,547,200
236 To Utah Department of Corrections - Department Medical Services
237 From General Fund
($2,000,000)
238 Schedule of Programs:
239 Medical Services ($2,000,000)
240 To Insurance Department - Insurance Department Administration
241 From General Fund Restricted Account - Insurance Department
242 Restricted Account
$90,600
243 Schedule of Programs:
244 Insurance Department - Administration $90,600