Senator Brian E. Shiozawa proposes the following substitute bill:




Chief Sponsor: Brian E. Shiozawa

House Sponsor: James A. Dunnigan


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

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" [is as] means the same as that term is defined in Section 31A-1-301.
55          (2) The department and the governor shall not expand the state's Medicaid program to
56     the [optional] adult expansion population under PPACA unless:

57          [(a) the Health Reform Task Force has completed a thorough analysis of a statewide
58     charity care system;]
59          [(b) the department and its contractors have:]
60          [(i) completed a thorough analysis of the impact to the state of expanding the state's
61     Medicaid program to optional populations under PPACA; and]
62          [(ii) made the analysis conducted under Subsection (2)(b)(i) available to the public;]
63          [(c) the governor or the governor's designee has reported the intention to expand the
64     state Medicaid program under PPACA to the Legislature in compliance with the legislative
65     review process in Sections 63M-1-2505.5 and 26-18-3; and]
66          (a) the department implements a program for the adult expansion population in
67     accordance with Subsection (3); or
68          [(d)] (b) notwithstanding Subsection 63J-5-103(2), the governor submits the request
69     for expansion of the Medicaid program for [optional] the adult expansion populations to the
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.
148          [(8)] (9) Section 26-38-2.5 is repealed July 1, 2017.
149          [(9)] (10) Section 26-38-2.6 is repealed July 1, 2017.

150          [(10)] (11) Title 26, Chapter 56, Hemp Extract Registration Act, is repealed July 1,
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

183               Schedule of Programs:
184                    Administration                    $5,600
185          To Department of Health - Medicaid and Health Financing
186               From General Fund, One-time

187               From Federal Funds

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

192               From Federal Funds

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

203               From Federal Funds

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

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

213               From Federal Funds

214               Schedule of Programs:
215                    Director's Office                    $1,437,000
216          To Department of Health - Medicaid Optional Services
217               From General Fund

218               From General Fund, One-time

219               From Federal Funds

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

224               From Federal Funds

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

231               From General Fund, One-time

232               From Federal Funds

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

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

243               Schedule of Programs:
244                    Insurance Department - Administration     $90,600