UTAH’S MEDICAID REFORM 1115 DEMONSTRATION

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What is Utah’s Medicaid Reform 1115 Demonstration?

Section 1115 of the Social Security Act gives states the flexibility to design and improve their programs, and to demonstrate and evaluate state-specific policy approaches to better serve Medicaid populations.

When a state submits an 1115 demonstration amendment proposal*, the Centers for Medicare and Medicaid Services (CMS) reviews the proposal to determine whether its stated objectives are aligned with federal policies and regulations. 1115 demonstrations must be "budget neutral" to the federal government, which means that, during the course of the project, federal Medicaid expenditures will not be more than federal spending without the demonstration. Generally, 1115 demonstrations are approved for an initial five-year period and can be extended for up to an additional three to five years, depending on the populations served.

The State is requesting authority to implement the provision of Senate Bill 96 "Medicaid Expansion Adjustments" which passed during the 2019 Utah Legislative Session. This waiver amendment proposes to increase the income limit for the Adult Expansion program to 138% federal poverty level (FPL), in addition to other program provisions and requirements. The following is pending CMS decision: