Fallback Plan Public Hearings

The Utah Department of Health will hold public hearings to discuss an amendment opens in a new tab to the 1115 Primary Care Network Demonstration.  The Department will accept public comment regarding this demonstration amendment during the 30-day public comment period from September 27, 2019 through October 27, 2019.

The Department is requesting authority to implement the provisions of Senate Bill 96 "Medicaid Expansion Adjustments", which passed during the 2019 Utah Legislative Session. The request includes the following provisions:

  • Increase the income limit for the Adult Expansion demonstration group from 95 percent of the federal poverty level (FPL) to 133 percent FPL, in order 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 members
  • Implement a Medicaid lock-out period for committing an intentional program violation
  • Provide housing related services and supports
  • Not allow hospitals to make presumptive eligibility determinations for the Adult Expansion members
  • Allow for certain flexibilities in operating managed care
  • Require premiums for Adult Expansion members with income over 100 percent FPL
  • Require a $25 copayment for non-emergent use of the emergency department for Adult Expansion members with income over 100 percent FPL through 133 percent FPL
  • Expand the definitions for Targeted Adult Medicaid to include additional adults
  • Obtain authority through this waiver amendment to potentially implement defined flexibility and cost savings provisions through the state administrative rulemaking process:
    • Require that Adult Expansion members with income over 100% FPL pay their monthly premium prior to receiving Medicaid for the eligible month
    • Not allow retroactive eligibility for Adult Expansion members with income over 100% FPL and enroll these adults prospectively in Medicaid
    • Change the benefit package for all adults on Medicaid expansion (including Targeted Adults, but excluding medically frail) to the State’s non-traditional benefit package
    • Exempt certain groups from the mandatory employer sponsored insurance (ESI) requirement
    • Suspend housing supports
    • Make enrollment in an integrated plan or other managed care mandatory or options for different groups on Medicaid expansion
    • Open or suspend enrollment for each population group or subgroup within Targeted Adult Medicaid

In addition, the Department will also request to continue the following approved programs and provisions from Utah’s current 1115 Primary Care Network Demonstration:

  • Enrollment limits for the Adult Expansion and Targeted Adult members
  • Waiver of Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
  • Implement a community engagement requirement for Adult Expansion members
  • Provide premium reimbursement and wrap-around Medicaid coverage, to eligible Adult Expansion members who have access to ESI

Public Hearings

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

  • Monday, October 7, 2019
    4:00 p.m. to 6:00 p.m.
    Multi-Agency State Office Building
    195 N 1950 W, Salt Lake City, Utah
  • Thursday, October 10, 2019
    2:00 p.m. to 4:00 p.m. (during the Medical Care Advisory Committee (MCAC) meeting
    Cannon Health Building
    288 N 1460 W, Salt Lake City, Utah
    Room 125

A conference line is available 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 Thursday October 3, 2019.

Public Comment

A copy of the full public notice and proposed application is available here.

The public may comment on the proposed application opens in a new tab request during the 30-day public comment period from September 27, 2019 through October 27, 2019.  Comments may be submitted online or by:

Email: Medicaid1115waiver@utah.gov

Mail:  Utah Department of Health
     Division of Medicaid and Health Financing
     PO Box 143106
     Salt Lake City, UT 84114-3106
Attn: Jennifer Meyer-Smart