Status report on Utah’s new “Per Capita Cap Plan” 1115 waiver

CMS recently approved an expansion of Utah Medicaid services called the “Bridge Plan.” This new plan now allows the state to cover parents and adults without dependents who earn up to 100% of the federal poverty level. Utahns began to enroll in this program on April 1, 2019. The new program is expected to cover up to 90,000 new recipients, part of an ongoing Medicaid expansion in the state.


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This spring, the Utah Department of Health is expected to submit a new 1115 waiver to CMS. If approved by CMS, a new “Per Capita Cap Plan” would replace the “Bridge Plan.” The “Per Capita Cap Plan” would continue covering adults up to 100% of the federal poverty level, while also establishing a new list of provisions not included in previous expansion efforts.

These new provisions include:

  • Self-sufficiency requirement: A requirement that all able-bodied individuals who qualify for Medicaid be employed, actively looking for employment, enter a vocational training program, or volunteer for a non-profit for a minimum of twenty hours a week;
  • Enrollment cap: A cap on the number of individuals enrolled in, and eligible for,  Medicaid;
  • Up to 12-month continuous eligibility: The ability for an individual to continue to receive Medicaid for a period of 12 months, regardless if their income changes during the year. The state is already enrolled in the CHIP program, which grants continuous enrollment to children regardless of the family’s change in income during the year;
  • Employer-sponsored insurance enrollment: The ability to enroll in an employer-sponsored health care program;
  • Lock-out for intentional program violation provision: Restricts an individual from reapplying for care if they fail to meet certain Medicaid requirements to maintain their eligibility; and  
  • A per capita cap: A cap on what the federal government will pay a state for its Medicaid enrollees.

The Utah Department of Health reported that the new waiver has not yet been submitted. There is no official date set for its final submission, but the department explained that they have been working closely with CMS to answer several follow-up questions. These follow-up questions were in regard to the requirements of the waiver itself.

According to a CMS representative, they are still working closely with the state to review the waiver and prepare it for final submission. The representative explained that the best place to check for the first possible update is here.