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Medicaid work requirement bill revived after failing in committee

SALT LAKE CITY — A bill instructing the Utah Department of Health to implement a work requirement for Medicaid will get another chance to be heard by lawmakers despite being halted last week by the House Health and Human Services Committee.

The committee on Thursday voted to send SB172 back to the House Rules Committee with a formal request that it be referred to the state Health Reform Task Force for further study before the next legislative session.

However, the House Rules Committee on Friday opted to re-assign the bill to be heard by the House Revenue and Taxation Committee on Monday.

The move angered Dr. William Cosgrove, who represents the Utah chapter of the American Academy of Pediatrics at the Legislature and who strongly opposes the bill. He called it a "back-room deal."

"I assume that the legislative leadership do not wish to have this considered by that (Health and Human Services) Committee that has at least some awareness of the complexities of the ... Medicaid ecosystem," Cosgrove told the Deseret News in an email.

Cosgrove, who is also the vice chairman of the Utah Medical Advisory Committee tasked with counseling those who oversee the state Medicaid program, said other health advocates who oppose SB172 are also upset at the bill's unexpected revival.

Those who have spoken publicly against the bill include the Utah Health Policy Project, Voices for Utah's Children and the Disability Law Center.

Bill sponsor Sen. Dan Hemmert, R-Orem, told the Deseret News in a text message that "I can't speak for the (House Rules Committee) but I can say that I think it's worth retrying because it's a great bill with some important concepts."

"Frankly, no bill is really dead until the end of the session," Hemmert said. "I admit it's rare for a bill to get re-assigned, but it's far from unheard of. Just depends on how hard you work (the) system and I really care about this bill, so I'm working the system really hard.

"I was elected to get stuff done," he said.

Hemmert told the House Health and Human Services Committee on Thursday that the premise behind his bill was "How could we innovate with the Medicaid program?"

"There are things we could do within Medicaid to make it better, frankly," he said.

SB178 instructs the Utah Department of Health to "implement a work and community engagement requirement for certain eligibility groups in the Medicaid program," while exempting children, pregnant women, those who are disabled and the elderly.

"We're not trying to hurt people with this. We're not trying to take away benefits with this, but I think there's value in encouraging people, if they don't fall into those (exempt) groups, to work or to otherwise engage in a community engagement program," Hemmert said.

Rep. Edward Redd, R-Logan, said he was troubled that a Medicaid work requirement could have unintended consequences for some recipients.

"There's a lot of questions I have with people who have serious and persistent mental illness, but maybe aren't disabled," Redd said. "There's other people who need to get help before they can work and its seems to me like you're kind of putting the cart before the horse here, in my opinion, because some of these people are not going to be able to work until they get healthy."

Hemmert told the committee that while his bill defines groups that cannot be subject to a work requirement, it also gives the health department room to identify additional exceptions.

The Sutherland Institute and the Utah chapter of Americans for Prosperity, a conservative think tank and advocacy group, respectively, both testified in favor of SB172.

"By pursuing federal Medicaid waivers that help able-bodied Utahns achieve a lfietime of earned success for themselves, SB172 is anticipated to also improve the ability of Medicaid to meet the needs of Utahns who are more likely to need Medicaid over the long term, such as low-income children and mothers and the disabled," said Stan Rasmussen, vice president of policy and operations for Sutherland Institute.

New funding method

According to Hemmert, SB172 would only request that the state seek a work requirement waiver in the event that a separate request — one for block grant funding — is turned down by the federal government.

The language of the bill requests that the Utah Department of Health request a federal waiver allowing the state Medicaid program to be funded "according to a per capita block grant formula .... that includes an annual inflationary adjustment."

"That typically means for every enrollee on Medicaid, you get a certain amount of money," Hemmert told lawmakers Thursday. "It gives the money to the state and lets the state run its own Medicaid program."

Health department officials have said block grants could give Utah more autonomy in how it runs its Medicaid program, and Gov. Gary Herbert has lauded the idea, saying last year that it's the "best of all worlds."

"Just give me the money — we'll figure it out and do what we need to do in Utah," Herbert said in June.

But the Utah Health Policy Project has cautioned that block grant funding, as opposed to the open-ended federal funds currently in place, would ultimately require states to curtail Medicaid benefits for certain populations.

Funding Medicaid that way would force the state into making impossible choices over who is more deserving of keeping their unfettered access to the program, the health think tank and advocacy group warned last year.

Stacy Stanford, policy analyst for the Utah Health Policy Project, told the House Health and Human Services Committee on Thursday that Hemmert's proposed method for dispensing Medicaid spending "would lead to coverage shortfalls and budget shortfalls over time."

"This bill is overlooking countless crucial policy details," Stanford said. "When it comes to health care, the devil can truly live in the details, and the gaping holes in these proposals could prove dangerous for vulnerable Utahns."

Hemmert told the committee he had worked with the Department of Health for almost six months on the language of the bill, and that he tried to refrain from being overly specific in his requests of the agency because he trusts its decision-making.

"It's a relatively short bill, it's only four pages, and yet it has some big ideas," he said. "I feel it is appropriately descriptive and also appropriately vague."

But Rep. Ray Ward, R-Bountiful, said he felt the vagueness in the bill had more to do with uncertainty over major policy changes than with the concept of giving flexibility to state health officials.

"I'm not clear in my mind what I'm directing the Department of Health to do," Ward said. "If we're still at the point of deliberately defining the terms vaguely because we're not sure what we mean, then to me that means we're still at the point of studying it as opposed to directing them to (make changes)."

Hemmert told the Deseret News his bill will be updated to address concerns raised in committee last week.

SB172 passed the Senate 20-6 on Tuesday.