1     
CHILDREN'S HEALTH COVERAGE AMENDMENTS

2     
2023 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Luz Escamilla

5     
House Sponsor: James A. Dunnigan

6     

7     LONG TITLE
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;
22          ▸     creates the Alternative Eligibility Expendable Revenue Fund; and
23          ▸     makes technical changes.
24     Money Appropriated in this Bill:
25          This bill appropriates in fiscal year 2024:
26          ▸     to the Department of Health and Human Services -- Alternative Eligibility
27     Expendable Revenue Fund as an ongoing appropriation:
28               •     from General Fund, $4,500,000.
29     Other Special Clauses:
30          This bill provides a special effective date.
31          This bill provides a coordination clause.
32     Utah Code Sections Affected:
33     AMENDS:
34          26-40-102, as last amended by Laws of Utah 2019, Chapter 393
35          26-40-105, as last amended by Laws of Utah 2019, Chapter 393
36          63I-1-226, as last amended by Laws of Utah 2022, Chapters 194, 206, 224, 253, 255,
37     347, and 451
38     ENACTS:
39          26-40-117, Utah Code Annotated 1953
40     Utah Code Sections Affected by Coordination Clause:
41          63I-1-226, as last amended by Laws of Utah 2022, Chapters 194, 206, 224, 253, 255,
42     347, and 451
43     

44     Be it enacted by the Legislature of the state of Utah:
45          Section 1. Section 26-40-102 is amended to read:
46          26-40-102. Definitions.
47          As used in this chapter:
48          (1) "Child" means a person who is under 19 years [of age] old.
49          [(2) "Eligible child" means a child who qualifies for enrollment in the program as
50     provided in Section 26-40-105.]
51          [(3)] (2) "Member" means a child enrolled in the program.
52          [(4)] (3) "Plan" means the department's plan submitted to the United States Department
53     of Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
54          [(5)] (4) "Program" means the Utah Children's Health Insurance Program created by
55     this chapter.
56          (5) "Traditionally eligible child" means, subject to limitations created by the federal
57     government, a child who is:
58          (a) a citizen of the United States;
59          (b) a qualified non-citizen;
60          (c) a Supplemental Security Income recipient living in the United States on August 22,
61     1996, that meets the federal government's criteria for one of the grand-fathered Supplemental
62     Security Income recipient non-citizen groups; or
63          (d) a lawfully present child.
64          Section 2. Section 26-40-105 is amended to read:
65          26-40-105. Eligibility.
66          (1) [A child is eligible to] A traditionally eligible child may enroll in the program if the
67     child:
68          (a) is a bona fide Utah resident;
69          [(b) is a citizen or legal resident of the United States;]
70          [(c) is under 19 years of age;]
71          [(d)] (b) does not have access to or coverage under other health insurance, including
72     any coverage available through a parent or legal guardian's employer;
73          [(e)] (c) is ineligible for Medicaid benefits;
74          [(f)] (d) resides in a household whose gross family income, as defined by rule, is at or
75     below 200% of the federal poverty level; and
76          [(g)] (e) is not an inmate of a public institution or a patient in an institution for mental
77     diseases.
78          (2) A child who qualifies for enrollment in the program under Subsection (1) may not
79     be denied enrollment due to a diagnosis or pre-existing condition.
80          (3) (a) The department shall determine eligibility and send notification of the eligibility
81     decision within 30 days after receiving the application for coverage.
82          (b) If the department cannot reach a decision because the applicant fails to take a
83     required action, or because there is an administrative or other emergency beyond the
84     department's control, the department shall:
85          (i) document the reason for the delay in the applicant's case record; and
86          (ii) inform the applicant of the status of the application and time frame for completion.
87          (4) The department may not close enrollment in the program for a child who is eligible
88     to enroll in the program under the provisions of Subsection (1).
89          (5) The program shall:
90          (a) apply for grants to make technology system improvements necessary to implement
91     a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
92          (b) if funding is available, implement a simplified enrollment and renewal process.
93          Section 3. Section 26-40-117 is enacted to read:
94          26-40-117. Alternative eligibility -- Report -- Alternative Eligibility Expendable
95     Revenue Fund.
96          (1) A child who is not a traditionally eligible child may enroll in the program if:
97          (a) the child:
98          (i) has been living in the state for at least 180 days before the day on which the child
99     applies for the program; and
100          (ii) meets the requirements described in Subsections 26-40-105(1)(a) through (e); and
101          (b) the child's parent has unsubsidized employment.
102          (2) (a) Enrollment under Subsection (1) is subject to funds in the Alternative Eligibility
103     Expendable Revenue Fund.
104          (b) The department may create a waiting list for enrollment under Subsection (2)(a) if
105     eligible applicants exceed funds in the Alternative Eligibility Expendable Revenue Fund.
106          (3) Notwithstanding Section 26-40-106, the program benefits, coverage, and cost
107     sharing for a child enrolled under this section shall be equal to the benefits, coverage, and cost
108     sharing provided to a child who:
109          (a) is eligible under Subsection 26-40-105(1); and
110          (b) resides in a household that has a gross family income equal to 200% of the federal
111     poverty level.
112          (4) Notwithstanding Section 26-40-108, program services provided to a child enrolled
113     under this section shall be funded by the Alternative Eligibility Expendable Revenue Fund.
114          (5) Each year the department enrolls a child in the program under this section, the
115     department shall submit a report to the Health and Human Services Interim Committee before
116     November 30 detailing:
117          (a) the number of individuals served under the program;
118          (b) average duration of coverage for individuals served under the program;
119          (c) the cost of the program; and
120          (d) any benefits of the program, including data showing:
121          (i) percentage of enrolled individuals who had well-child visits with a primary care
122     practitioner at recommended ages;
123          (ii) percentage of enrolled individuals who received a comprehensive or periodic oral
124     evaluation;
125          (iii) percentage of enrolled individuals who received recommended immunizations at
126     recommended ages;
127          (iv) rate of emergency department visits per 1,000 member months;
128          (v) rate of medication adherence to treat chronic conditions; and
129          (vi) a comparison of utilization patterns before and after enrollment.
130          (6) (a) There is created an expendable special revenue fund known as the "Alternative
131     Eligibility Expendable Revenue Fund."
132          (b) The Alternative Eligibility Expendable Revenue Fund shall consist of:
133          (i) appropriations by the Legislature;
134          (ii) any other funds received as donations for the fund; and
135          (iii) interest earned on the account.
136          (c) If the balance of the Alternative Eligibility Expendable Revenue Fund exceeds
137     $4,500,000, state funds shall be transferred from the Alternative Eligibility Expendable
138     Revenue Fund to the General Fund in an amount equal to the amount needed to reduce the
139     balance of the Alternative Eligibility Expendable Revenue Fund to $4,500,000.
140          (d) Money in the Alternative Eligibility Expendable Revenue Fund shall be used to
141     provide benefits to a child enrolled in the program under this section.
142          Section 4. Section 63I-1-226 is amended to read:
143          63I-1-226. Repeal dates: Title 26 through 26B.
144          (1) Section 26-1-7.5, which creates the Utah Health Advisory Council, is repealed July
145     1, 2025.
146          (2) Section 26-1-40 is repealed July 1, 2022.
147          (3) Section 26-1-41 is repealed July 1, 2026.
148          (4) Section 26-1-43 is repealed December 31, 2025.
149          (5) Section 26-7-10 is repealed July 1, 2025.
150          (6) Subsection 26-7-11(5), regarding reports to the Legislature, is repealed July 1,
151     2028.
152          (7) Section 26-7-14 is repealed December 31, 2027.
153          (8) Section 26-8a-603 is repealed July 1, 2027.
154          (9) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
155     1, 2025.
156          (10) Subsection 26-10-6(5), which creates the Newborn Hearing Screening Committee,
157     is repealed July 1, 2026.
158          (11) Section 26-10b-106, which creates the Primary Care Grant Committee, is repealed
159     July 1, 2025.
160          (12) Subsection 26-15c-104(3), relating to a limitation on the number of
161     microenterprise home kitchen permits that may be issued, is repealed July 1, 2022.
162          (13) Subsection 26-18-2.6(9), which addresses reimbursement for dental hygienists, is
163     repealed July 1, 2028.
164          (14) Section 26-18-27 is repealed July 1, 2025.
165          (15) Section 26-18-28 is repealed June 30, 2027.
166          (16) Title 26, Chapter 18, Part 2, Drug Utilization Review Board, is repealed July 1,
167     2027.
168          (17) Subsection 26-18-418(2), the language that states "and the Behavioral Health
169     Crisis Response Commission created in Section 63C-18-202" is repealed July 1, 2023.
170          (18) Section 26-33a-117 is repealed December 31, 2023.
171          (19) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
172          (20) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1,
173     2024.
174          (21) Title 26, Chapter 36c, Medicaid Expansion Hospital Assessment Act, is repealed
175     July 1, 2024.
176          (22) Title 26, Chapter 36d, Hospital Provider Assessment Act, is repealed July 1, 2024.
177          (23) Section 26-39-201, which creates the Residential Child Care Licensing Advisory
178     Committee, is repealed July 1, 2024.
179          (24) Section 26-39-405, Drinking water quality in child care centers, is repealed July 1,
180     2027.
181          (25) Section 26-40-104, which creates the Utah Children's Health Insurance Program
182     Advisory Council, is repealed July 1, 2025.
183          (26) Section 26-40-117, regarding alternative eligibility, is repealed July 1, 2028.
184          [(26)] (27) Section 26-50-202, which creates the Traumatic Brain Injury Advisory
185     Committee, is repealed July 1, 2025.
186          [(27)] (28) Title 26, Chapter 54, Spinal Cord and Brain Injury Rehabilitation Fund and
187     Pediatric Neuro-Rehabilitation Fund, is repealed January 1, 2025.
188          [(28)] (29) Title 26, Chapter 66, Early Childhood Utah Advisory Council, is repealed
189     July 1, 2026.
190          [(29)] (30) Title 26, Chapter 68, COVID-19 Vaccine Restrictions Act, is repealed July
191     1, 2024.
192          [(30)] (31) Section 26-69-406 is repealed July 1, 2025.
193          [(31)] (32) Subsection 26B-1-204(2)(i), related to the Residential Child Care Licensing
194     Advisory Committee, is repealed July 1, 2024.
195          [(32)] (33) Subsection 26B-1-204(2)(k), related to the Primary Care Grant Committee,
196     is repealed July 1, 2025.
197          Section 5. Appropriation.
198          The following sums of money are appropriated for the fiscal year beginning July 1,
199     2023, and ending June 30, 2024. These are additions to amounts previously appropriated for
200     fiscal year 2024. Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures
201     Act, the Legislature appropriates the following sums of money from the funds or accounts
202     indicated for the use and support of the government of the state of Utah.
203     ITEM 1
204     To Department of Health and Human Services - Alternative Eligibility Expendable Revenue
205     Fund
206          From General Fund
4,500,000

207          Schedule of Programs:
208               Alternative Eligibility Expendable Revenue Fund          4,500,000
209          Section 6. Effective date.
210          This bill takes effect on January 1, 2024.
211          Section 7. Coordinating S.B. 217 with S.B. 208 -- Substantive and technical
212     amendments.
213          If this S.B. 217 and S.B. 208, Health and Human Services Recodification - Cross
214     References, Titles 58-63J, both pass and become law, the Legislature intends that the Office of
215     Legislative Research and General Counsel prepare the Utah Code database for publication on
216     January 1, 2024, as follows:
217          (1) the amendments to Section 63I-1-226 in S.B. 208 supersede the amendments to
218     Section 63I-1-226 in this bill; and
219          (2) add the language "Section 26-40-117, regarding alternative eligibility, is repealed
220     July 1, 2028." as a subsection to Section 63I-1-226 in this bill, numerically according to title
221     placement after Section 26-40-117 has been technically renumbered to Title 26B, in
222     accordance with the revisor instructions in S.B. 208.