Pub. 3 2019 Issue 1

O n April 1, 2019, more Utah adults gained access to Medicaid than ever before. Under the newly approved Medicaid Expansion plan, approximately 70,000–90,000 Utah resi- dents became newly eligible forMedicaid. Adults who earn up to 100 percent of the federal poverty level, about $12,492 for an individual or $25,752 for a family of four, is eligible to receive full Medicaid benefits. Additionally, eligible individu- als must be a Utah resident between the ages of 19 and 64, and be a U.S. citizen or legal resident. For more infor- mation or to apply online, visit https:// medicaid.utah.gov/apply-medicaid. Submitting an application for benefits does not guarantee coverage. Enrollees in the Primary Care Network (PCN) (approximately 15,000) were auto-enrolled inMedicaid as part of the expansion population, as PCN closed on March 31, 2019. The Targeted Adult Medicaid (TAM) program will continue to operate as it does today. The State estimates that enrollment in the TAM program will decrease, as some adults will elect to enroll in the newly created expansion Medicaid rather than TAM. Under this new expansion program, parents will receive the Non-Tradition- al Medicaid benefit package. Adults without dependent children will re- ceive the Traditional Medicaid benefit package. Both programs cover doctor visits, prescriptions, hospital care, am- bulance, behavioral health services, specialty care and more. This new eligibility group comes at the direction of Senate Bill 96 (2019 Legis- lative Session), sponsored by Sen. Allen Christensen and Rep. Jim Dunnigan. The bill supersedes previous Medicaid Expansion efforts and replaces Propo- sition 3 (2018 General Election). Under the current waiver, the federal govern- ment will cover approximately 70 per- cent of the cost of the new program; the State of Utah will cover the remain- ing 30 percent. This spring, the State also submited a new 1115 Waiver to CMS called the Per Capita Cap Plan. If approved, this plan will replace the plan implemented on April 1, 2019. The Per Capita Cap Plan covers adults up to 100 percent FPL and requests the following provi- sions: self-sufficiency requirement, enrollment cap, up to 12-month con- tinuous eligibility, employer-sponsored insurance enrollment, lock-out for in- tentional program violation provision, and a per capita cap. This plan will also request 90 percent federal/10 percent state funding. The State is optimis- tic that the Centers for Medicare and Medicaid Services (CMS) will provide greater flexibility as Utah crafts its own Medicaid Expansion solutions. Through these waivers, many new in- dividuals will now be eligible for Med- icaid coverage in Utah. The State has prepared communication tools to help spread the word. You can download flyers, posters and FAQs on the Medic- aid website: https://medicaid.utah.gov/ expansion. For more information and regular updates, visit the Medicaid website: https://medicaid. utah.gov/expansion Utah Medicaid Expansion By Kolbi Young Public Information Officer Division of Medicaid and Health Financing Utah Department of Health 37 |