SB 172: Greater Flexibility in Administering Medicaid

This bill passed the Senate 20-6 but was held and not voted on in the House.

Last month, the federal government provided instructions to states on how they might apply for and receive a Medicaid waiver that would require select participants to work or prepare for jobs as a condition of obtaining the taxpayer-funded welfare money. Waivers for flexility within this welfare program have historically been applied for, and received, by the state of Utah.

Senator Dan Hemmert is sponsoring Senate Bill 172 to instruct the Utah Department of Health to seek waivers to administer the Medicaid program:

• with a work and community engagement requirement, which would not apply to a child, pregnant woman, or disabled person;
• with more direct primary care payment models;
• with a two-month limit on retroactive eligibility; and
• with an option for a medical savings account.

The Department is also instructed to seek a waiver to operate the Medicaid program, in whole or in part, pursuant to a block grant that “increases the state’s control” over the types of services provided, the manner in which they are delivered and funded, eligibility requirements, or enrollee cost sharing.

Senator Hemmert sponsored a resolution last year, which passed overwhelmingly, which maintained that “Utah is best suited to make decisions regarding Medicaid policy for the residents of this state” and calling on the federal government “to work with states to plan and implement state-tailored, innovative Medicaid programs, through means such as a federal block grant or a per capita allocation, that maximize states’ flexibility and choice.”

In March 2017, the Secretary of the U.S. Health and Human Services along with the Administrator of the Centers for Medicare and Medicaid Services co-signed a letter to each governor, calling it a “new era” where “states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population.” They continued:

We wish to empower all states to advance the next wave of innovative solutions to Medicaid’s challenges—solutions that focus on improving quality, accessibility, and outcomes in the most cost-effective manner. States, as administrators of the program, are in the best position to assess the unique needs of their respective Medicaid-eligible populations and to drive reforms that result in better health outcomes.

Senate Bill 172 is the culmination of this intent and planning, and would provide the flexibility needed to improve taxpayer efficiency in administering this welfare program.