What do we know about Utah’s Coverage Options?

• Medicaid is a state-federal health insurance program for qualified low-income children and adults

• Utah began offering Medicaid in 1966

• In Utah, the state pays 30% of Medicaid costs, the federal government pays 70%

What is Medicaid?

405,000 Utahns received Medicaid in 2014

The largest Medicaid recipient category in Utah are children under age 19 (238,950 recipients)

Utah adults without children aren’t eligible for Medicaid at any income level

59.0% 13.8%

11.8%

4.0%

6.4% 5.0%

Children (age 0-18)

Parents

Visually Impaired and People with Disabilities

Elderly (age 65+)

Pregnant Women

Primary Care Network (PCN)

Source: Utah Dept. of Health 2014 Medicaid Report (p. 29); http://health.utah.gov/medicaid/stplan/LegReports/MedicaidAnnualReport_2014.pdf

• People who can’t receive Medicaid include adults without kids, parents who earn more than 50% of poverty, and people with unqualified disabilities

• Many people who don’t quality for Medicaid are uninsured and live in Utah’s “Coverage Gap”

Who isn’t eligible for Medicaid?

0% 100%

How does Full Expansion differ from Partial?

0% 100% 138%

70%

30%

10%

90%

STATE

FEDERAL

WHO PAYS

$82 million/year $513 million/year

Partial Expansion Full Expansion TYPE

PEOPLE COVERED

TAXES RETURNED*

Source Cost estimates based on Milliman Numbers Revised 12 /17/14 and Dept. of Health Estimates 03/03/15; Taxes Returned data for 2017.

What is costs, who is covers, and tax dollars returned…

Predicted State Cost of Full vs. Partial Expansion Plans (in $1,000’s)

$(2,400)

$18,700

$35,900 $45,000

$61,700

$77,800 $70,100

$99,200

$107,400 $116,500

$126,200 $136,300

$(10,000)

$30,000

$70,000

$110,000

$150,000

FY 16 FY 17 FY 18 FY 19 FY 20 FY 21

Revised consensus numbers (12/18/14)

Full Expansion (0%-138% FPL)

Partial Expansion (0%-100% FPL)

Full expansion costs Utah taxpayers less than partial

Newly Eligible 0% to 100% FPL

34,000

36,000

37,500

39,500

53,000

63,000

64,500

66,000

68,000

69,500

Newly Eligible 101% to 138% FPL

32,000

19,500 FY 16

FY 17

FY 18

FY 19

FY 20

FY 21

89,000

Enrollment by Eligibility & Poverty Level for Full Expansion

126,500

131,000

136,000

141,000

146,000

TOTA

L ENR

OLLM

ENT

Woodwork Effect 0%-100% FPL

16,500

31,500

32,500

34,000

35,500

37,500

100% of Poverty

Most eligible Utahns live under the poverty level

Revised consensus numbers (12/18/14)

Annual income: $21,000

% of poverty level: 89%

Expected contribution: 100%

Monthly premium (for 2): $418

The Smith’s pay: $418

Subsidy pays $0

Source: Kaiser Family Foundation Subsidy Calculator; http://kff.org/interactive/subsidy-calculator; Image source: Fotozaic

The Smith Family Income: $21,000 Residence: Orem, Utah Ages: Dad : 35 Mom: 33 Child: 7 Child: 11

No Subsidy

The Smith’s healthcare costs would be 24% of their total income

Who lives in the Coverage Gap?

What is Utah’s Primary Care network (PCN)?

PCN is a Medicaid waiver program that provides basic coverage to 18,000 Utahns who don’t quality for Medicaid

PCN is NOT comprehensive health insurance.

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@UHPP

What to learn more?

Utah Health Policy Project (UHPP)

1832 Research Way

Suite 60

Salt Lake City, Utah

84119