Update on Utah’s Per Capita Cap Plan

Following a recent public hearing on the state’s Medicaid expansion efforts and the 1115 waiver, several members of the Medical Care Advisory Committee submitted a letter expressing opposition to several new provisions in the plan. 

One portion of the 1115 waiver, 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. Some of these provisions include an enrollment cap, a self-sufficiency requirement, and spending caps.

The plan was submitted to CMS this spring. If this proposal is denied, there are a number of alternative plans that could be implemented. 

Ten of the 19 members of the committee signed on to a letter directed to the Utah Department of Health asking state and national officials to reject the proposals made in the new 1115 waiver. They cited the risk of health and security concerns for many of Utah’s beneficiaries as the reason for the rejection. 

“As an advisory committee, we believe that many of the components and programs proposed in this waiver application undermine the objectives of the Medicaid program and the stated goals of the waiver which is “to furnish medical assistance [to individuals and families] whose income and resources are insufficient to meet the costs of necessary medical services and rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care,” the committee commented in the June 30th letter. 

The main areas of concern, as expressed in the letter are: a per-capita funding scheme that could leave the state liable for increased health care costs without matching federal funds; enrollment caps that could exclude otherwise eligible patients from Medicaid if funding runs dry; a requirement that patients prove they are working, looking for work, or engaged in other qualifying activities to participate in Medicaid; and the elimination of some Medicaid benefits for 19- and 20-year-old patients.