What Utah's Move to Restrict Medicaid Expansion May Mean for MCOs

by Leslie Small

In November's midterm elections, Utah voters approved a ballot initiative to expand Medicaid. Now, though, Utah has passed a law that requires state officials to apply for a waiver that would implement a more limited form of Medicaid expansion, which could make things tricky for the state's Medicaid managed care organizations.

Utah's new law directs the state to submit a Section 1115 waiver application that seeks to cover a capped number of nonelderly adults with incomes of up to 100% of the federal poverty level (FPL), rather than at 138% of the FPL under full Medicaid expansion.

If CMS doesn't approve that waiver request, full Medicaid expansion would go into effect, but with some caveats. If that, too, fails to gain federal approval, an unrestricted form of Medicaid expansion would go into effect by July 1, 2020.

"Uncertainty is definitely the first word that comes to mind," Patricia Boozang, a senior managing director at Manatt Health, tells AIS Health when asked how Utah's legislation will affect the state's Medicaid MCOs.

One potential source of that uncertainty is whether Utah's waiver request will get approved — making it unclear when the state's Medicaid expansion will occur, she says. And if Utah's waiver is approved, it could see legal challenges similar to those challenging Kentucky and Arkansas' work requirements waivers, creating another source of uncertainty, Boozang notes.

"In Kentucky, for instance, they're really relying on their health plans to implement features of their waiver, and there has been at least two starts and stops" due to litigation, she says.

From Health Plan Weekly