This document includes House Committee Amendments incorporated into the bill on Tue, Feb 28, 2023 at 11:05 AM by pflowers.



Chief Sponsor: Luz Escamilla

House Sponsor: James A. Dunnigan


8     General Description:
9          This bill creates alternative eligibility requirements for the Children's Health Insurance
10     Program.
11     Highlighted Provisions:
12          This bill:
13          ▸     modifies definitions;
14          ▸     creates alternative eligibility requirements for the Children's Health Insurance
15     Program;
16          ▸     allows the department to create a waiting list for applicants eligible under the
17     alternative eligibility requirements;
18          ▸     specifies what benefits a child may receive if eligible under the alternative eligibility
19     requirements;
20          ▸     limits enrollment for children who are eligible under the alternative eligibility
21     requirements; and
22          ▸     makes technical changes.
23     Money Appropriated in this Bill:
24          This bill appropriates in fiscal year 2024:
25          ▸     to the Department of Health and Human Services -- Integrated Health Care
26     Services, Children's Health Insurance Program Services as an ongoing
27     appropriation:

28               •     from the General Fund, $4,500,000
29     Other Special Clauses:
30          This bill provides a special effective date.
31     Utah Code Sections Affected:
32     AMENDS:
33          26-40-102, as last amended by Laws of Utah 2019, Chapter 393
34          26-40-105, as last amended by Laws of Utah 2019, Chapter 393
35          26-40-106, as last amended by Laws of Utah 2021, Chapter 175
36          26-40-108, as last amended by Laws of Utah 2010, Chapter 391

38     Be it enacted by the Legislature of the state of Utah:
39          Section 1. Section 26-40-102 is amended to read:
40          26-40-102. Definitions.
41          As used in this chapter:
42          (1) "Child" means a person who is under 19 years [of age] old.
43          [(2) "Eligible child" means a child who qualifies for enrollment in the program as
44     provided in Section 26-40-105.]
45          [(3)] (2) "Member" means a child enrolled in the program.
46          [(4)] (3) "Plan" means the department's plan submitted to the United States Department
47     of Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
48          [(5)] (4) "Program" means the Utah Children's Health Insurance Program created by
49     this chapter.
50          (5) "Traditionally eligible child" means, subject to limitations created by the federal
51     government, a child who is:
52          (a) a citizen of the United States;
53          (b) a qualified non-citizen;
54          (c) a Supplemental Security Income recipient living in the United States on August 22,
55     1996, that meets the federal government's criteria for one of the grand-fathered Supplemental
56     Security Income recipient non-citizen groups; or
57          (d) a lawfully present child.
58          Section 2. Section 26-40-105 is amended to read:

59          26-40-105. Eligibility.
60          (1) (a) [A child is eligible to] A traditionally eligible child may enroll in the program if
61     the child:
62          [(a)] (i) is a bona fide Utah resident;
63          [(b) is a citizen or legal resident of the United States;]
64          [(c) is under 19 years of age;]
65          [(d)] (ii) does not have access to or coverage under other health insurance, including
66     any coverage available through a parent or legal guardian's employer;
67          [(e)] (iii) is ineligible for Medicaid benefits;
68          [(f)] (iv) resides in a household whose gross family income, as defined by rule, is at or
69     below 200% of the federal poverty level; and
70          [(g)] (v) is not an inmate of a public institution or a patient in an institution for mental
71     diseases.
72          (b) Subject to Subsection (4)(b), a child who is not a traditionally eligible child may
73     enroll in the program if:
74          (i) the child:
75          (A) has been living in the state for at least Ĥ→ [
90] 180 ←Ĥ days before the day on which
75a     the child
76     applies for the program; Ĥ→ [
and] ←Ĥ
77          (B) meets the requirements described in Ĥ→ [
Subsection (1)(a)] Subsections (1)(a)(i)
77a     through (iii) and (v) ←Ĥ ; and
77b     Ĥ→ (C) resides in a household whose gross family income, as defined by rule, is at or above
77c     100% of the federal poverty level and does not exceed 200% of the federal poverty level;
77d     and ←Ĥ
78          (ii) the child's parent has unsubsidized employment.
79          (2) A child who qualifies for enrollment in the program under Subsection (1) may not
80     be denied enrollment due to a diagnosis or pre-existing condition.
81          (3) (a) The department shall determine eligibility and send notification of the eligibility
82     decision within 30 days after receiving the application for coverage.
83          (b) If the department cannot reach a decision because the applicant fails to take a
84     required action, or because there is an administrative or other emergency beyond the
85     department's control, the department shall:
86          (i) document the reason for the delay in the applicant's case record; and
87          (ii) inform the applicant of the status of the application and time frame for completion.
88          (4) (a) The department may not close enrollment in the program for a child who is
89     eligible to enroll in the program under the provisions of Subsection (1)(a).

90          (b) Enrollment under Subsection (1)(b) is subject to state appropriation.
91          (c) The department may create a waiting list for enrollment under Subsection (1)(b) if
92     eligible applicants exceed state appropriations.
93          (5) The program shall:
94          (a) apply for grants to make technology system improvements necessary to implement
95     a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
96          (b) if funding is available, implement a simplified enrollment and renewal process.
97          Section 3. Section 26-40-106 is amended to read:
98          26-40-106. Program benefits.
99          (1) Except as provided in Subsection (3), medical and dental program benefits shall be
100     benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
101          (a) medical program benefits, including behavioral health care benefits, shall be
102     benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
103          (i) be substantially equal to a health benefit plan with the largest insured commercial
104     enrollment offered by a health maintenance organization in the state; and
105          (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No.
106     110-343; and
107          (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1
108     every third year thereafter in accordance with the Children's Health Insurance Program
109     Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the
110     largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the
111     state, except that the utilization review mechanism for orthodontia shall be based on medical
112     necessity.
113          (2) On or before July 1 of each year, the department shall publish the benchmark for
114     dental program benefits established under Subsection (1)(b).
115          (3) The program benefits:
116          (a) for enrollees who are at or below 100% of the federal poverty level are exempt
117     from the benchmark requirements of Subsections (1) and (2); and
118          (b) shall include treatment for autism spectrum disorder as defined in Section
119     31A-22-642, which:
120          (i) shall include coverage for applied behavioral analysis; and

121          (ii) if the benchmark described in Subsection (1)(a) does not include the coverage
122     described in this Subsection (3)(b), the department shall exclude from the benchmark described
123     in Subsection (1)(a) for any purpose other than providing benefits under the program.
124          (4) Notwithstanding any other provision of this section, the program benefits,
125     coverage, and cost sharing for a child enrolled under Subsection 26-40-105(1)(b) shall be equal
126     to the benefits, coverage, and cost sharing provided to a child who:
127          (a) is eligible under Subsection 26-40-105(1)(a); and
128          (b) resides in a household that has a gross family income equal to 200% of the federal
129     poverty level.
130          Section 4. Section 26-40-108 is amended to read:
131          26-40-108. Funding.
132          (1) [The] Except as provided in Subsection (3), the program shall be funded by federal
133     matching funds received under, together with state matching funds required by, 42 U.S.C. Sec.
134     1397ee.
135          (2) Program expenditures in the following categories may not exceed 10% in the
136     aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee:
137          (a) other forms of child health assistance for children with gross family incomes below
138     200% of the federal poverty level;
139          (b) other health services initiatives to improve low-income children's health;
140          (c) outreach program expenditures; and
141          (d) administrative costs.
142          (3) If the state is unable to obtain federal matching funds for a child eligible through
143     Subsection 26-40-105(1)(b), the program services provided to the child shall be funded by the
144     state.
145          Section 5. Appropriation.
146          The following sums of money are appropriated for the fiscal year beginning July 1,
147     2023, and ending June 30, 2024. These are additions to amounts previously appropriated for
148     fiscal year 2024. Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures
149     Act, the Legislature appropriates the following sums of money from the funds or accounts
150     indicated for the use and support of the government of the state of Utah.
151     ITEM 1

152     To Department of Health and Human Services -- Integrated Health Care Services
153          From General Fund

154          Schedule of Programs:
155               Children's Health Insurance Program Services          4,500,000
156          The Legislature intends that the Department of Health and Human Services use the
157     appropriation under this item to enroll children described in Subsection 26-40-105(1)(b) in the
158     Utah Children's Health Insurance Program.
159          Section 6. Effective date.
160          This bill takes effect on January 1, 2024.