5 Things Utah: Q&A w/ Rich Saunders, Cox’s budget, DHHS transition plan


Eli Kirshbaum


This is the last “5 Things” newsletter before the holidays, so we want to wish all of you a wonderful and safe holiday season!

This newsletter includes a conversation with Rich Saunders, details on the DHHS transition plan, and health items in Gov. Cox’s budget.

Thanks for reading, and we’ll see you in 2022!

Eli Kirshbaum
State of Reform 


1. Q&A: Rich Saunders on Gov. Cox’s health priorities

Rich Saunders, former UDOH director and current senior advisor to Gov. Cox, recently told State of Reform about some of the governor’s health priorities for 2022. They include implementing value based care, continuing the state’s COVID response, and addressing “government efficiencies” like the lack of a single methodology for gathering stakeholder feedback on government services.

Saunders also discussed Cox’s Utah Sustainable Health Collaborative—a broad initiative that consults providers, patients, legislators, and more to try and reduce rising health care costs in the state. “This patient-centric, neutrally managed collaborative will focus on sustainable health care and coordinating efforts in order to reduce these costs … [it will also focus] very deliberately on equity.”


2. DHHS transition plan released

UDOH and DHS submitted their transition plan for the consolidated Department of Health and Human Services to the governor and the legislature on Dec. 1. The result of months of stakeholder engagement, the plan focuses on avoiding the disruption of services, aligning overlapping services, and modifying statutory language to reflect the new department’s structure. The DHHS Steering Committee will continue to work with the governor and the legislature in the coming months before the department’s July 1 implementation.

Tracy Gruber, executive director of DHS, said the legislature needs to review over 1,600 pages of state code to align with the department’s new legal structure. UDOH Executive Director Nate Checketts said DHHS is prioritizing working with more CBOs and clinics to identify additional populations that can receive Utah Medicaid Integrated Care.

3. Health items in Cox’s budget

Gov. Cox released his budget recommendations earlier this month, which include $7.6 billion for the soon-to-be-operational DHHS. This is around $200 million less than the state allocated to health and human services in last fiscal year’s finalized budget. Cox also calls for $228 million for affordable housing, $4.5 million for UETN telehealth kits, and $3.2 million for the Utah Sustainable Health Collaborative.

The budget allocates $68 million in ongoing GF dollars to supporting changes in Medicaid enrollment and caseload, as well as inflationary changes. This includes $1.1 million in ongoing funding for continuous Medicaid eligibility for children. Nate Talley, deputy director and chief economist at the Governor’s Office of Planning and Budget, emphasized that this funding is dependent on when the PHE ends and triggers a drop in Medicaid enrollment.


4. The 2020 national health expenditures report

CMS’s Office of the Actuary’s National Health Expenditures Team recently released their annual report on national health spending, which shows significant pandemic-induced changes in US health care spending last year. In his most recent piece, State of Reform columnist James Capretta breaks down some of the report’s main findings about changes in national health care expenditures during 2020.

Overall national health expenditures increased from $3.8 trillion in 2019 to $4.1 trillion in 2020. The private sector spent 0.6% less on health care in 2020 because employers paid less for employee health care due to the large number of people who lost their jobs, Capretta explains. He also notes that since the federal government increased their share of Medicaid spending in response to the pandemic, state health care expenditures decreased by 3.1% in 2020 compared to 2019.

5. Leaders highlight equity gaps in Utah health care

Experts talked through Utah’s health equity needs during a panel at the Utah Health Policy Project’s recent conference. Diximar Paredes Bolli of Alliance Community Services and UHPP’s Daryl Herrshaft both highlighted the need to eliminate technological barriers when signing up for health coverage in the state, including hard-to-understand insurance websites and a Medicaid application process that isn’t culturally competent.

Shireen Ghorbani, director of community health at Intermountain Healthcare, called for action to cover the 82,000 Utah children without health insurance. With 40% of these children being Hispanic/Latinx, Ghorbani called on the legislature to address this “incredible disparity.”