Families USA State Comment Letter on Utah “Fallback Plan” 1115 Amendment

Families USA submitted this letter in response to Utah’s request for comments on its proposed application to amend its section 1115 waiver to expand Medicaid eligibility to cover individuals up to 138% of the Federal Poverty Level, along with a number of additional provisions.

As noted in a Families USA analysis, the proposed amendment, which is referred to as the “Fallback Plan,” is the state’s fourth attempt to expand Medicaid coverage in accordance with state legislation subverting the full Medicaid expansion that voters approved last November. With this amendment, the state is finally proposing – in light of CMS’ rejection of its per capita cap waiver – to fully expand Medicaid. In addition, the state is proposing to add new housing-related services, a work reporting requirement, mandatory enrollment in employer-sponsored insurance, enrollment limits, a waiver of EPSDT benefits, lock-outs, waivers of presumptive and retroactive eligibility, new premiums and cost-sharing, limited benefits for adults with dependent children, and additional managed care flexibilities.

Families USA supports the state’s decision to finally expand its Medicaid program and we encourage the state to submit a state plan amendment to fully expand as soon as possible consistent with state legislation. However, many of the proposal’s additional provisions jeopardize beneficiaries’ coverage and should not be implemented. Read the rest of our comment here.