2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 2 - Medicaid Waivers › Section 210 - Medicaid waiver expansion.

Effective 5/3/2023
26B-3-210.
Medicaid waiver expansion.
(1) As used in this section:
(a) "Federal poverty level" means the same as that term is defined in Section 26B-3-207.
(b) "Medicaid waiver expansion" means an expansion of the Medicaid program in accordance with this section.
(2)
(a) Before January 1, 2019, the department shall apply to CMS for approval of a waiver or state plan amendment to implement the Medicaid waiver expansion.
(b) The Medicaid waiver expansion shall:
(i) expand Medicaid coverage to eligible individuals whose income is below 95% of the federal poverty level;
(ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for enrolling an individual in the Medicaid program;
(iii) provide Medicaid benefits through the state's Medicaid accountable care organizations in areas where a Medicaid accountable care organization is implemented;
(iv) integrate the delivery of behavioral health services and physical health services with Medicaid accountable care organizations in select geographic areas of the state that choose an integrated model;
(v) include a path to self-sufficiency, including work activities as defined in 42 U.S.C. Sec. 607(d), for qualified adults;
(vi) require an individual who is offered a private health benefit plan by an employer to enroll in the employer's health plan;
(vii) sunset in accordance with Subsection (5)(a); and
(viii) permit the state to close enrollment in the Medicaid waiver expansion if the department has insufficient funding to provide services to additional eligible individuals.
(3) If the Medicaid waiver described in Subsection (2)(a) is approved, the department may only pay the state portion of costs for the Medicaid waiver expansion with appropriations from:
(a) the Medicaid Expansion Fund, created in Section 26B-1-315;
(b) county contributions to the non-federal share of Medicaid expenditures; and
(c) any other contributions, funds, or transfers from a non-state agency for Medicaid expenditures.
(4)
(a) In consultation with the department, Medicaid accountable care organizations and counties that elect to integrate care under Subsection (2)(b)(iv) shall collaborate on enrollment, engagement of patients, and coordination of services.
(b) As part of the provision described in Subsection (2)(b)(iv), the department shall apply for a waiver to permit the creation of an integrated delivery system:
(i) for any geographic area that expresses interest in integrating the delivery of services under Subsection (2)(b)(iv); and
(ii) in which the department:
(A) may permit a local mental health authority to integrate the delivery of behavioral health services and physical health services;
(B) may permit a county, local mental health authority, or Medicaid accountable care organization to integrate the delivery of behavioral health services and physical health services to select groups within the population that are newly eligible under the Medicaid waiver expansion; and
(C) may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to integrate payments for behavioral health services and physical health services to plans or providers.
(5)
(a) If federal financial participation for the Medicaid waiver expansion is reduced below 90%, the authority of the department to implement the Medicaid waiver expansion shall sunset no later than the next July 1 after the date on which the federal financial participation is reduced.
(b) The department shall close the program to new enrollment if the cost of the Medicaid waiver expansion is projected to exceed the appropriations for the fiscal year that are authorized by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter 1, Budgetary Procedures Act.
(6) If the Medicaid waiver expansion is approved by CMS, the department shall report to the Social Services Appropriations Subcommittee on or before November 1 of each year that the Medicaid waiver expansion is operational:
(a) the number of individuals who enrolled in the Medicaid waiver program;
(b) costs to the state for the Medicaid waiver program;
(c) estimated costs for the current and following state fiscal year; and
(d) recommendations to control costs of the Medicaid waiver expansion.
Renumbered and Amended by Chapter 306, 2023 General Session