The Utah Department of Health announced plans in late December to implement full Medicaid expansion in 2020. That means adults with household incomes up to 138 percent of the federal poverty level—$17,236 a year for an individual or $35,535 for a family of four—are now eligible for Medicaid coverage.
Medicaid is a public health insurance program for people with low incomes and limited resources. An estimated 68,000 people became eligible for Medicaid in April 2019, when a limited expansion for people earning up to 100 percent of the federal poverty line was implemented. The state estimates another 45,000 people are now Medicaid-eligible under the full expansion. Close to 34,000 individuals enrolled with fee-for-service Medicaid when it expanded in 2019.
Intermountain is already caring for many of the people affected by the expansion through charity care and in our emergency departments. Medicaid expansion will allow these people to see primary care doctors and move their care out of EDs and into traditional outpatient settings.
“A lot of these folks live right on the bubble economically, and in the absence of this coverage they haven’t been getting preventive care,” said CEO Marc Harrison, MD. “As the largest portion of Utah’s safety net, Intermountain will care for them regardless, but now we’re going to get a chance, hopefully, to keep them well as opposed to having them show up in an emergency department or elsewhere with more advanced health complications.”
How will the Medicaid expansion affect patient volumes at Intermountain? Greg Matis, Intermountain’s deputy general counsel, said, “Some people worry we’re going to be flooded with patients. There will likely be some initial build-up in demand for services early in the year, but we’re probably not going to see dramatic utilization surges. But it’s hard to know for sure what will happen. We don’t expect very much impact on Primary Children’s Hospital because children were already covered under Medicaid—this expansion population is largely adults—but all the Medicaid expansion news coverage may encourage some new families to seek care for their children at Primary Children’s.”
Doug Hammer, Intermountain’s senior vice president of legal affairs and general counsel, says initial estimates of how many people would be included in Medicaid expansion don't appear to be accurate. “We just haven’t seen the numbers yet,” he said. “Some officials were claiming well over 100,000 people would receive coverage under the expansion, but so far the numbers appear to be much lower.”
How will the Medicaid expansion affect SelectHealth? SelectHealth manages a Medicaid Accountable Care Organization called Community Care. Medicaid expansion enrollees must transition from fee-for -service Medicaid to an Accountable Care Organization this year. SelectHealth Community Care has received 8,400 of those members so far and SelectHealth leaders estimate expansion membership will grow to about 20,000 by the end of 2020.
Other Utah insurance providers also offer Medicaid products. Intermountain will care for people who enroll with most of those insurers as well.
Many of the people covered by Medicaid expansion are already receiving insurance coverage through the Affordable Care Act exchange and some of them are likely to keep their current insurance rather than shifting to Medicaid.
Now that the full expansion has taken effect, Utah will receive full Medicaid expansion funding from the federal government for the entire Medicaid expansion population under the Affordable Care Act's guidelines. That means the federal government will cover 90 percent of Utah’s Medicaid expansion costs and the state will cover the remaining 10 percent.
Utah lawmakers feared full Medicaid expansion would be a budget buster, so they initially overrode Proposition 3—an initiative to fully expand Medicaid that was passed by Utah voters in 2018—and sought a series of federal matches and waivers, but legislators also approved full expansion as a fallback. The proposed matches and waivers were rejected by the Trump administration, so the full Medicaid expansion is now in place as proposed by voters, with these exceptions approved by the Centers for Medicaid and Medicare: There’s a work requirement for some people and if people can get coverage through their employer, they'll be required to seek that coverage—with Medicaid helping with their premium. Learn more at medicaid.utah.gov/expansion.
“In the end, we know people who have health insurance are healthier than people who don’t have health insurance,” said Dr. Harrison. “My very simplistic thinking about this expansion is, thousands of human beings are going to shift from the category of being uncovered into being covered. Hopefully that’ll make their lives brighter and healthier.”