Meausure Twice, Cut Once: Utah's Approach to Medicaid Expansion under the Affordable Care Act

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1 Meausure Twice, Cut Once: Utah's Approach to Medicaid Expansion under the Affordable Care Act Associate General Counsel, Office of Legislative Research and General Counsel Utah Legislature Presentation to CSG West July 31, 2015

2 Expansion Status

3 Coverage Gap Coverage Gap The covergage gap Source: Utah Department of Health, presented July 10, 2012 to the Health Reform Task Force with annotation by Office of Legislative Research and General Counsel. Available at "2.2 Income Limits for Medicaid and CHIP Eligibility" under "Meeting Materials" for the July 10, 2012 meeting of the task force at Note: This chart does not reflect that under the ACA, children 6 18 are moved from CHIP to Medicaid.

4 Federal Revenues & Spending

5 Behaviors Newly eligible (uptake and risk) Woodwork Crowd-out Uncertainty over system changes Expiration of reinsurance and risk corridors Additional delays or changes in implementation (agencies, congress) Uncertainty over budget impacts Sustainability of federal funding Sustainability of state funding Budgetary crowd-out

6 : Budget Crowd-Out

7 Quandary Quantity The decision maker's quandary Time

8 Quandary Quantity The decision maker's quandary Time

9 Quandary Quantity The decision maker's quandary Where are we? Time

10 Quandary Process Governor Process Outside consultant Medicaid actuary Legislature Fiscal notes Coordination

11 Quandary Process Opportunities Reform Opportunities Integration of medical and behavioral health care Payment and delivery ACOs Telehealth Savings Reductions in cost shifting due to uncompenstated or undercompensated care Between uninsured and insured Between government-funded and commercial coverage (depending on reimbursement rates) Across populations (e.g., from persons with untreated mental illness or substance use disorders to others, including taxpayers)

12 Quandary Process Opportunities Results Results Framework for proposal Coverage Funding Sustainability

13 Quandary Process Opportunities Results Conclusions Conclusions Whether a state chooses to expand Medicaid eligibility reflects the value it places on certain policy outcomes. Those values differ between expansion and nonexpansion states. remain. Better-quality information is forthcoming and will permit more accurate evaluation of each state's expansion decision.

14 Questions or Comments? Contact Associate General Counsel, Office of Legislative Research and General Counsel Utah Legislature

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