1     
MEDICAID WAIVER AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Daniel Hemmert

5     
House Sponsor: Daniel McCay

6     

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

28     

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          [(3)] (5) Title 26, Chapter 46, Utah Health Care Workforce Financial Assistance
107     Program, is repealed July 1, 2027.
108          [(4)] (6) Title 26, Chapter 59, Telehealth Pilot Program, is repealed January 1, 2020.






Legislative Review Note
Office of Legislative Research and General Counsel