PRINCIPLES FOR MEDICAID FUNDING DECISIONS IN THE 2012 GENERAL SESSION
Background
The state’s latest revenue estimate identified nearly $300 milllion in new ongoing revenues, removing a major barrier to the
full funding of Medicaid and CHIP caseloads going forward. The decision in 2011 to shortfund the programs was made in
anticipation of a brighter revenue picture in 2012. Now it is time for Utah’s policy makers to follow through and eliminate
the Medicaid and CHIP deficit. At the same time, Utah should continue working to limit growth in Medicaid spending and
do so by following the path to accountable care set out by SB 180 enacted in the 2011 General Session.
As Utah proceeds with its own efforts to reform and strengthen the state’s health care system, Medicaid will continue to
play a critical role as a purchaser of health care services for Utahns who otherwise would have no where to go but the more
expensive emergency room when they are sick. If Medicaid is not there to pay that ER bill and the patient can’t pay, then
every Utahn with insurance will pay in the form of higher premiums for their own coverage. Utah policy makers have the
opportunity to ensure that Medicaid is the smartest health care purchaser it can be. That is the responsible path to limiting
growth in Medicaid spending.
In that spirit, the Utah Medicaid Partnership offers the following principles to help guide the deliberations of Utah’s policy
makers.
The Principles
1.
Fully funding caseload growth is an acknowledgement that Utah will meet its obligations to Utahns served by
Medicaid and to the health care professionals that provide their care. The marketplace is watching Utah. Private
companies will have to decide whether to bid on the state’s accountable care business when the state asks for
proposals. Funding caseloads demonstrates to the marketplace that Utah is a reliable business partner. This is the
time to fully fund caseload growth.
2.
Recognize Medicaid’s value and role as a critical safety net during the continuing economic recovery. Tax
revenues follow the business cycle, but countercyclical programs like Medicaid naturally grow as unemployment
rises, incomes fall, and job based insurance declines. Medicaid and CHIP continue to be needed by Utah families
working hard to get back on their feet.
3.
The state’s leadership is proceeding wisely in addressing the state’s structural deficit. This approach helps to
make whole programs like Medicaid, which create or support jobs and generate revenue and by virtue of the
federal match rate of 3-to-1, serve as drivers of economic growth.
4.
Payment and delivery system reforms are central to the accountable care model Utah has endorsed for our
Medicaid program. While Medicaid transitions to accountable care, Utah policy makers can act now to generate
more savings and better health outcomes.
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5.
6.

Utah needs to start now on developing a plan for the integration of behavioral and medical health
services to better manage cost and improve health outcomes for Utahns with mental illness.

In improving the reporting of healthcare facilities on healthcare acquired infections, Utah can save money
by preventing the need for expensive treatment.

New service delivery models need to be part of any strategy for improving Utahns oral health and
helping sustain a restored dental benefits for adult Utahns enrolled in Medicaid.

Contain Medicaid costs by ensuring that Utah families with children with chronic conditions or
disabilities can access appropriate care through coordination of Medicaid and private insurance
coverage.
Re-invest any savings in cost-effective areas of the program. For example:

Ensure that the long-term services and supports needs of older adults and people with disabilities are fully
addressed in planning for their integration into accountable care. To the extent possible, end the bias in
favor of institutional care at the expense of enabling people to continue to live in community.

Bring provider rates to levels that will support access to cost-effective primary and specialty care.
Use the time allocated for the 45-day General Session to build on Utah’s existing Medicaid reform initiative.

Focus discussion on cost-effective investments to meet the long-term goals of accountable care, including
payments to providers to motivate care in appropriate settings and services that will give Utah’s elderly
and people with disabilities enrolled in Medicaid the choice to stay in their homes and communities
instead of going into nursing homes.

Before considering any program reduction, legislative leaders should communicate with federal officials
about what does and does not qualify for federal matching funds.
Conclusion
Medicaid and CHIP caseloads should be fully funded as state leaders look for ways to sustain spending over the long term
through payment and delivery system reforms and proven cost containment measures.
The Utah Medicaid Partnership is a broad-based coalition of community organizations and individuals working to ensure
that the Utah Medicaid program provides access to quality, affordable and comprehensive health care coverage to eligible
Utahns.
To endorse these principles please email [email protected]