5 Things Utah: Budget review, Public comments on waiver, Bill Stilling

November is a great time of year to show a little extra gratitude… So, with that in mind, thank you for reading our stuff. Thanks also to those folks that come to speak and attend our conference earlier this year. Your engagement and support is what holds our entire enterprise together.

We’re about 5 months away from next year’s event, so consider this the warning for what will be a great time on April 2nd. Until then, here are 5 Things we think are worth keeping an eye on in Utah health policy in November.





1. State waiver responds to public comments

On November 1, Utah submitted to CMS its “Fallback Plan” to reform Medicaid and expand eligibility. In a cover letter, Gov. Herbert requested an expedited review to get the waiver approved by December 31, 2019 — itself an ambitious goal. The submission included 24 pages of state responses to 99 public comments Utah’s DOH had received during the public review process.

Among the responses, the state clarified that the Housing Related Services and Supports (HRSS) portion of the waiver will only apply to a “targeted” subset of the expansion population, a provision some argue is contrary to SB 96. One commenter argued SB 96 didn’t eliminate all presumptive eligibility in Medicaid, as this plan attempts, but only “limits” it. Another complained that the state had to file Medicaid rates with CMS on October 1, well before any approval of this plan, putting MCOs and the state in an unpredictable financial position, with considerable downside risk.

No substantive public comments have yet been filed with CMS on the “Fallback Plan.”


2. Video: Bill Stilling, Stilling and Harrison

Our “What They’re Watching” series is an opportunity for health care professionals to share the topics and subjects that they are tracking in health care today. The series now numbers over 500 installments. We think it’s a useful opportunity to extend the thought leadership that occurs at our conferences out into the digital space.

This edition, we hear from Bill Stilling, a partner at the law firm Stilling and Harrison. The firm is the only health care-only firm headquartered in Utah. Stilling is a former pharmacist, so he has a provider-informed view of regulatory and legal issues. In his comments, he highlights the uncertainty around the possible ACA repeal, the challenge of new dispensary laws, and the sometimes-tension between pharmacists and payers.


3. Individual market appears to finally be stabilizing

At the recent Health Reform Task Force meeting, a presentation by the Utah Insurance Department showed the individual insurance market appears to have stabilized for the first time since its launch in 2014. In the aggregate, rates are down 1.8% over last year after falling 1.5% in plan year 2018. The average monthly premium for a silver plan, including those with subsidies, is $75.

Plan year 2018 also showed an aggregated medical loss ratio of 85%, which is the target. It had been as high as 138% in 2015, meaning payments for care delivery exceeded total premium collections by 38%. 202,500 are estimated to have been enrolled in individual market plans in 2019.

4. Health, human services budget review

The Social Services Appropriations Subcommittee recently reported to the full committee on its interim work to review 20% of its budget, line item by line item. HJR 18 from the session requires the subcommittee to review 1/5th of the budget each year, so that it gets a hard look at least once every 5 years.

The report says the subcommittee will seek to establish a “baseline measure” for Medicaid expansion, tracking “how many people get out of poverty.” It reviewed the possibility of outsourcing the Office of Health Care Statistics, but wanted to further explore using the office to leverage a greater federal Medicaid draw down. The subcommittee didn’t approve staff recommended cuts to the Inter-generational Poverty Initiative passed in HB 326. Cuts were proposed as a result of some counties being unable to meet accountability and reporting measures.

5. Salt Lake County looking at BH in budget

Counties across the state are finalizing budgets. Salt Lake County will hold a public hearing on its council-proposed budget on December 3rd. While 88% of the Salt Lake County budget goes to public safety, there is an amount of funding towards behavioral health in the budget, with some newly proposed investments in BH for 2020.

The Mayor’s budget proposal includes $358K for two new mental health professionals and two new registered nurses for the “Jail Medical Unit” under the sheriff. The BH budget is mostly flat, but does include one additional FTE to work on data issues and HIT. It’s a relatively tight ship for a budget of $117m.