Federal Comment Letter on Utah "Fallback Plan" 1115 Amendment - Families Usa Skip to Main Content

Federal Comment Letter on Utah “Fallback Plan” 1115 Amendment


Families USA submitted this letter in response to CMS’s request for comments on Utah’s proposal to amend its section 1115 waiver to expand Medicaid eligibility to cover individuals up to 138% of the Federal Poverty Level and add a number of additional provisions that negatively impact beneficiaries.

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. However, many of the proposal’s additional provisions jeopardize Utahns’ benefits and coverage and should not be approved by CMS or implemented by the state. Read the rest of our comment here.