1115 Demonstration Application – Per Capita Cap Public Hearings

The Utah Department of Health, Division of Medicaid and Health Financing (DMHF) will hold public hearings to discuss a new section 1115 demonstration application.  DMHF will also accept public comment regarding this demonstration application during the 30-day public comment period from May 31, 2019 through June 30, 2019.

DMHF is requesting authority to implement the provisions of Senate Bill 96 "Medicaid Expansion Adjustments," which passed during the 2019 Utah Legislative Session.  DMHF will submit a new 1115 demonstration application to request authority to implement these provisions. The provisions of Senate Bill 96 include:

• Authority to receive the full Federal Medical Assistance Percentage (FMAP) allowable under 42 U.S.C. Section 1396d(y) for the Adult Expansion and Targeted Adult Populations
• Implement a per capita cap funding mechanism
• Implement a lock-out for committing an Intentional Program Violation for Medicaid
• Federal expenditure authority to provide housing related services and supports
• Allow up to 12-months of continuous eligibility for the Adult Expansion Medicaid population
• Not allowing hospitals to make presumptive eligibility determinations for the Adult Expansion Medicaid population
• Allow for managed care flexibilities.

In addition, the DMHF will also include in this request, to transition the following approved programs and provisions from Utah’s approved 1115 Primary Care Network Demonstration, to this new application:

• Adult Expansion Population
• Targeted Adult Population, including dental benefits for Targeted Adults who are receiving substance use disorder (SUD) treatment
• Clinically managed residential withdrawal pilot for the Adult Expansion and Targeted Adult Populations only
• SUD treatment benefits for the Adult Expansion and Targeted Adult Populations only
• Enrollment limits for the Adult Expansion and Targeted Adult Populations
• Waiver of Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
• Implement a community engagement requirement under the full FMAP for the Adult Expansion Medicaid Population
• Provide premium reimbursement and wrap-around Medicaid coverage under full FMAP, to eligible Adult Expansion individuals who have access to employer-sponsored insurance

The DMHF will conduct two public hearings to discuss the demonstration application.  The dates, times and locations are listed below:

• Thursday, June 6, 2019
  2:00 p.m. to 4:00 p.m. (as part of the Medical Care Advisory Committee (MCAC) meeting)
  Cannon Health Building
  288 N 1460 W, Salt Lake City, Utah
  Room 125


• Monday, June 17, 2019
  4:00 p.m. to 6:00 p.m
  Multi-Agency State Office Building
  195 N 1950 W, Salt Lake City, Utah
  Room 1020

A conference line is available for both public hearings for those who would like to participate by phone: 1-877-820-7831, passcode 378804#.

Individuals requiring an accommodation to fully participate in either meeting may contact Jennifer Meyer-Smart at 801-538-6338 by 5:00 p.m. on Tuesday, June 4, 2019.