Political insiders discuss the impact 2024’s legislative session will have on Medicaid funding in Utah


Maddie McCarthy


The Utah Legislature wrapped up its 65th legislative session on March 1. Policy experts discussed the session’s outcomes at the 2024 Utah State of Reform Health Policy Conference on March 7.

Rachel Craig, government affairs manager at the Association for Utah Community Health, said this year’s session saw fewer gains in the Medicaid space compared to recent sessions.

“There isn’t a lot of money that is willingly going to go around to support Medicaid and healthcare initiatives, generally, with some exceptions,” Craig said.

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One of those exceptions was the passage of Senate Bill 181, sponsored by Sen. Luz Escamilla (D-Salt Lake County), which directs Medicaid to cover traditional healing services for American Indian/Alaska Native people.

Craig noted that Medicaid was not expanded to cover more pregnant people, however. In order to be eligible for coverage in Utah, a pregnant person’s household income cannot exceed 144 percent of the federal poverty level (FPL). Craig said Utah has one of the lowest income thresholds in the country.

Rep. Raymond Ward (R-Davis County) advocated to increase the income threshold to 185 percent of the FPL through House Bill 193, but the House Business and Labor Committee removed that provision from the bill. 

Carrie Butler, executive director of the Utah Public Health Association (UPHA), said some lawmakers need to better understand the importance of safety-net programs like Medicaid.

“My perspective is that there’s a lot more education that needs to be done, specifically when it comes to healthcare and the way our systems work, the interdependence that they have on some of our safety net programs, and why they matter [as a] whole,” Butler said.

Daniel Sloan, health policy analyst at Utah Health Policy Project, also expressed concern about Medicaid funding, and said there are strong allies from all parties who support its expansion. 

Sloan highlighted the passage of HB 501, sponsored by Rep. James Dunnigan (R-Salt Lake County), which allows qualified incarcerated individuals to acquire Medicaid coverage just before their release. The bill goes into effect on May 1.

“[HB 501] provides Medicaid coverage to certain inmates 90 days before they’re released from a carceral setting,” Sloan said. “That’s great news. It also provides behavioral health funds to counties to help them provide those services to those who are in transition from the carceral setting to the community.”

Sloan said transitional services for incarcerated people help reduce recidivism and support healthier communities.

Frank R. Pignanelli, senior managing partner at Foxley and Pignanelli, said regardless of the 2024 legislature’s outcomes, the legislative process is working as it should. He said Utah lawmakers work with the community on bills to ensure citizen voices are heard, which is comparatively more difficult to achieve at the national level.

“I’m going to be optimistic. The legislative process is a good process. It’s a participatory process … The legislators, whether you like what they do or not, make the process available to people and provide input. That is a refreshing thing.”

— Pignanelli

Pignanelli said there were three overarching healthcare themes from the 2024 session: cost of prescription drugs, medical licensure, and insurance coverage. Not all of the bills relating to those issues passed, but seeing them in the legislature meant lawmakers are moving forward on addressing them.

Craig discussed HB 463, sponsored by Rep. Brady Brammer (R-Utah County). Although the bill did not pass, Craig had many concerns about HB 463, and feels similar legislation will be presented in the future

HB 463 would have provided clarity for defining a Medicaid shortfall, and defined cuts that would be made to Medicaid in the event of a shortfall. A shortfall could occur as a result of an operating deficit, inaccurate appropriations to Medicaid, or a drop in the Federal Medical Assistance Percentage (FMAP), Craig said.

Utah’s current FMAP is 64.36 percent, meaning the state funds 35.64 percent of its social services, like Medicaid. A state’s FMAP can never fall below 50 percent. Craig said a drop in the FMAP should not indicate a shortfall because it means the state is becoming wealthier. 

“[According to the bill] when that shortfall happens, if the Executive Appropriations Committee doesn’t appropriate more money to the program within 45 days, there would start to be cuts to the program,” Craig said.

Craig said cuts could include freezing salaries, rolling back provider reimbursement increases, and cutting drug reimbursement benefits and  other services considered to be optional by the federal government.

“Optional does not mean ‘not medically necessary,’” Craig said. “Most of the services and the population Utah covers are technically optional.”

Sloan noted that HB 463 did not have a hearing in the Health and Human Services Committee as one would expect, but was reviewed by the Business and Labor Committee. 

“It didn’t feel like it was being taken seriously,” Sloan said. “It didn’t feel like anyone was interested in collaborating with advocates or with plans or anyone.”

Butler said she expects more bills that would cut Medicaid funding to be introduced in future sessions.

“It’s really disconcerting to me that when we’re looking at budget cuts, we only ever look at the Medicaid program. Nobody ever goes to (the Utah Department of Transportation) and says, ‘We’re going to cut some of your funding for roads.’ They never do that. Nobody ever goes to some of these other agencies or programs and says, ‘We would like you to take a hard look at your necessary, life-saving interventions and decide what is possible for us to get rid of.’”

— Butler

Pignanelli said the legislative process worked with HB 463 because Brammer chose to circle the bill at its second hearing. The bill had significant public opposition, with 13 opponents—including organizations like UPHA, Mountain Land Physical Therapy, Voices for Utah Children, and the Utah Department of Health and Human Services—speaking against various aspects of the bill at its first hearing.

Brammer told Speaker Mike Shultz that he counted 38 votes in favor of HB 463—which is the minimum number of votes a bill can have and pass the Utah House—so he wanted to make changes to the bill and bring it back to the legislature at a later time.

Pignanelli said he has worked in the lawmaking space since the late 1980s, and over the years, the legislature has had to make vital budget cuts due to economic emergencies.

“I must compliment Rep. Brammer that he’s trying to deal with something that could happen down the road if—and I hope it doesn’t happen—some type of economic disaster [occurs],” Pignanelli said.

It is important to recognize incremental changes in legislation, Pignanelli said. He cited mental health advocacy as an example. Mental health advocates struggled to get the legislature’s attention 20 years ago, Pignanelli said. Now lawmakers from all sides of the political spectrum are considering options to deal with the state’s mental health crisis

The legislature passed numerous mental and behavioral health bills this year. Rep. Evan Vickers’ (R-Beaver County) SB 27 is notable as it creates the Utah Behavioral Health Commission.

“Take the little victories because you can then turn those into larger victories,” Pignanelli said.

Butler said she hopes lawmakers consider evaluating legislation from a public health perspective.

“I know we pass a whole lot of bills up there that have fiscal notes attached that create programs that we then consistently have to ask for money for or to fund, and oftentimes we don’t know if those things are really working,” Butler said.

Butler advised organizations that are impacted by the legislature’s decisions to develop an evaluation process for their programs in order to either advocate for more funding or advocate for different programs.

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