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7 LONG TITLE
8 General Description:
9 This bill authorizes certain changes and waivers for the Medicaid program.
10 Highlighted Provisions:
11 This bill:
12 ▸ requires the Department of Health to implement certain changes to the Medicaid
13 program;
14 ▸ authorizes the Department of Health to apply for waivers or a state plan amendment
15 if necessary to implement the changes in this bill;
16 ▸ creates various reporting requirements; and
17 ▸ creates repeal dates for the reporting requirements in this bill.
18 Money Appropriated in this Bill:
19 None
20 Other Special Clauses:
21 None
22 Utah Code Sections Affected:
23 AMENDS:
24 63I-2-226, as last amended by Laws of Utah 2017, Chapters 126, 155, 413, and 419
25 ENACTS:
26 26-18-415, Utah Code Annotated 1953
27 26-18-416, Utah Code Annotated 1953
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29 Be it enacted by the Legislature of the state of Utah:
30 Section 1. Section 26-18-415 is enacted to read:
31 26-18-415. Medicaid reform waivers -- Reporting requirements.
32 (1) (a) The department shall, to the fullest extent allowed under federal law, implement
33 a work and community engagement requirement for certain eligibility groups into the Medicaid
34 program.
35 (b) The work and community engagement requirement described in Subsection (1)(a)
36 does not apply to a person who is:
37 (i) a child;
38 (ii) pregnant; or
39 (iii) disabled.
40 (2) The department shall, to the fullest extent allowed under federal law, incorporate
41 one or more direct primary care payment models into the Medicaid program.
42 (3) The department shall, to the fullest extent allowed under federal law, implement a
43 two-month limit on retroactive eligibility for eligibility groups, as determined by the
44 department, that may not need a longer period of retroactive eligibility.
45 (4) The department shall, to the fullest extent allowed under federal law, design and
46 administer a medical savings account program for enrollees in the Medicaid program.
47 (5) The department:
48 (a) if the waiver described in Section 26-18-416 is not approved, may not implement
49 the components described in Subsections (1) through (4) without federal matching funds at a
50 rate that is greater than or equal to the federal medical assistance percentage, as defined in 42
51 U.S.C. Sec. 1396d(b); and
52 (b) shall design the components described in Subsections (1) through (4) to:
53 (i) reduce the cost of the Medicaid program to the state;
54 (ii) promote enrollee health and self-sufficiency; and
55 (iii) create incentives to utilize health care resources wisely.
56 (6) If necessary to implement the components described in Subsections (1) through (4),
57 the department shall apply for a waiver or a state plan amendment with the Center for Medicare
58 and Medicaid Services within the United States Department of Health and Human Services:
59 (a) before January 1, 2019, to implement the components described in Subsections (1)
60 through (3); and
61 (b) before July 1, 2019, to implement the component described in Subsection (4).
62 (7) (a) Before January 1, 2019, the department shall report to the Social Services
63 Appropriations Subcommittee and the Health and Human Services Interim Committee on
64 options for creating a Medicaid waiver request that would authorize the state to limit Medicaid
65 spending growth by limiting the services received by one or more Medicaid eligibility groups.
66 (b) The options developed by the department in Subsection (7)(a) shall:
67 (i) consider the clinical effectiveness and cost of services covered by the Medicaid
68 program;
69 (ii) require input from an independent body consisting of medical professionals,
70 consumers, and health insurers; and
71 (iii) be designed to reduce the costs of the Medicaid program to the state.
72 (8) Before January 1, 2019, the Department of Workforce Services shall report to the
73 Social Services Appropriations Subcommittee and the Health and Human Services Interim
74 Committee on:
75 (a) processes that the Department of Workforce Services uses for determining and
76 verifying eligibility for the Medicaid program; and
77 (b) recommendations to improve the accuracy and reduce the cost of determining and
78 verifying eligibility for the Medicaid program.
79 Section 2. Section 26-18-416 is enacted to read:
80 26-18-416. Medicaid block grant waiver -- Reporting requirement.
81 (1) Before July 1, 2018, the department shall apply for a Medicaid waiver with the
82 Centers for Medicare and Medicaid Services within the United States Department of Health
83 and Human Services to implement the proposal developed under Subsection (2).
84 (2) The department shall develop a proposal for the state to administer the Medicaid
85 program, or a portion of the Medicaid program:
86 (a) with federal funds provided to the state according to a per capita block grant
87 formula developed by the department; and
88 (b) in a manner that increases the state's control over one or more of the following:
89 (i) the types of services provided;
90 (ii) the manner in which services are delivered and paid for;
91 (iii) eligibility requirements; or
92 (iv) enrollee cost sharing.
93 (3) (a) Before June 1, 2018, and in accordance with the requirements in Subsection
94 26-18-3(3), the department shall report to the Social Services Appropriations Subcommittee
95 and the Health and Human Services Interim Committee on the proposal developed under
96 Subsection (2).
97 (b) After submitting the waiver application under Subsection (1), the department shall
98 report any modifications to the waiver application to the Social Services Appropriations
99 Subcommittee and the Health and Human Services Interim Committee.
100 Section 3. Section 63I-2-226 is amended to read:
101 63I-2-226. Repeal dates -- Title 26.
102 (1) Section 26-8a-107 is repealed July 1, 2019.
103 (2) Subsections 26-10-12(2) and (4) are repealed July 1, 2017.
104 (3) Subsections 26-18-415(7) and (8) are repealed January 1, 2020.
105 (4) Subsection 26-18-416(3) is repealed January 1, 2025.
106 [
107 Program, is repealed July 1, 2027.
108 [
Legislative Review Note
Office of Legislative Research and General Counsel