Utah received approval from the Centers for Medicare and Medicaid Services, under the Health and Human Services Department, in March to move forward with a Medicaid expansion to provide access to health insurance for up to 90,000 low-income adults. Under that agreement, the federal government will pay for 70 percent of the expanded program, with the state funding the remaining 30 percent. People have been able to apply for coverage since April 1.
Under the Affordable Care Act, the federal government may pay for more than 90 percent of the program, as it does in the more than 30 other states that have expanded Medicaid, and Utah hoped to receive such support. But Utah is different from other states that expanded health insurance because it decided to extend eligibility to a more limited number of residents than is permitted under the ACA.
The Trump administration does not plan to approve enhanced federal funding for any state that implements a partial Medicaid expansion, two senior administration officials said. The Obama administration also did not grant such funding for states that did not expand the program fully as the law envisioned, in an effort to encourage states to expand health insurance to as many residents as possible.
The reasoning from the Trump administration is different, however.
The administration is siding with 18 Republican attorneys general arguing in federal court that the entirety of the Affordable Care Act — which extended health insurance to some 20 million Americans through individual marketplaces and expansion of Medicaid — is unconstitutional. A decision f
rom the U.S. Court of Appeals for the 5th Circuit is expected in the coming weeks.
According to the senior officials, who spoke on the condition of anonymity to discuss internal deliberations, White House advisers argued that it did not make sense to approve generous federal funding under the ACA while the administration is arguing that the entire law should be overturned.
White House advisers on the Domestic Policy Council, Office of Management and Budget, and National Economic Council, which are controlled by conservative Republicans, were the staunchest opponents of allowing Utah to receive enhanced federal funding for its expanded Medicaid program. CMS Administrator Seema Verma presented Utah’s argument for receiving the enhanced funding in a meeting with several White House and health agency officials, but the decision to deny such requests was ultimately unanimous, a senior administration official said.
Utah said it still plans to submit a funding request to the CMS. “We’re still preparing to submit our waiver as directed by state legislation passed this year,” said Tom Hudachko, spokesman for the Utah Department of Health. “We have not received any indication, one way or the other, how CMS may act on the waiver once we do submit it.”
The White House deferred to the CMS for comment, and the CMS declined to comment on the decision.
Utah voters approved a ballot measure in November that would have fully expanded Medicaid as allowed under Obamacare to individuals earning up to 138 percent of the federal poverty level. The state’s Republican leaders overruled voters and submitted their own proposal to the CMS to expand the program to residents who earn up to 100 percent of the federal poverty level, which is $12,490 a year for an individual and $25,750 for a family of four. The state also included a requirement that most Medicaid beneficiaries work or else lose their benefits, requirements that Kentucky and Arkansas tried to implement but that were blocked by a federal judge.
Under Obamacare, the federal government funded the entirety of the Medicaid expansion for two years before gradually shifting more of the costs back to the states. More than 30 states expanded Medicaid under the 2010 law, and a handful of states have voted to implement an expansion since Trump took office in 2017.
“We are now unified — this administration is charting a conservative course forward, and the president gave us a clear directive,” said a senior administration official.
Republicans repeatedly failed to repeal and replace Obamacare — which was a top Republican campaign promise for eight years — in 2017 despite controlling the White House and both chambers of Congress. Republicans lost control of the House of Representatives in 2018, in large part because of the unpopularity of their repeal-and-replace efforts and Democrats’ promises to protect and strengthen Obamacare.