H.B. 15 Medicaid Amendments: transcript

substitute Medicaid amendments, is that correct? That is, that is correct. Thank you. Uh, Mr. Chair Pro tem, um, oh, what, what do you know? Just in time. Okay. Um, HB 15 was an interim bill, um, actually a unanimous interim bill. We've made some changes to its since then. Uh, let me just give you a little background about the genesis of the bill. Um, I'm, I'm sure you're all familiar with, uh, HR one often referred to in Congress as the big beautiful bill. Uh, that bill made, uh, significant changes to, uh, many parts of the federal budget, including Medicaid. Uh, the original version of the house Bill, uh, had some potential changes in it that, uh, we realized were going to trigger, um, or trip or trigger law. Um, and if the bill would've been signed, if, if the original version of the house bill would've gone through and would've been signed on June 30th, we would've Sunset Medicaid on July 1st. Now, let me give you a little bit of background. This bill isn't about whether we have Medicaid expansion or not. That was a, a citizen, a ballot initiative referendum that passed. And, um, despite concerns from, from many in the legislature, including myself, the funding mechanism that was put in place has generated far more revenue than has been expended on the program. Currently in the A A CA Reserve fund stabilization account, there's approximately, last I checked, 342 million as kind of a, a rainy day account. Uh, one of the things that HR one did is, uh, require put in place a work requirement. Estimates are from our fiscal analyst. Um, I might be off a small tiny percentage here. I think 27.4% they estimate is gonna be the disenrollment once the work requirement gets into place. So the fund will have, uh, significantly more funds in that because, uh, if there's changes in enrollment, in adult expansion, that in no way changes the sales tax that is collected for the the program. So the bottom line is, is that for the expansion population, it's going to be going down significantly. And from a financial perspective, it is in a very strong position. During interim, the bill that the passed unanimously after a very thorough analysis, thorough analysis from the fiscal analyst, showed that we could easily go down to 85% fmap and still be financially solvent. Um, the substitute still still leaves, or the substitute leaves the, the, the trigger law at 90%. So if Congress, uh, makes additional changes, which I was told by a member of Congress in person yesterday that they're planning on this bill is simply trying to be proactive to make sure that the legislature is in a position to, uh, understand those changes and react to them within a reasonable amount of time. So currently, um, the way the trigger law works is, if anything trips that trigger law, then it would Sunset on July 1st. This bill is so, so theoretically if they tripped it on July 2nd, it would Sunset a year later on July 1st. This bill is not extending that window of one year. It is simply modifying it. So we would have at least one legislative session that we could react to those potential changes. Another thing that was in HR one is it said if a state extends any sort of Medicaid benefit or Medicaid type benefit like Utah has done to undocumented children, that would automatically Sunset, uh, expansion. This bill says if Congress uh, passes such legislation, we will automatically Sunset that type of population. So in Utah's case, that would be for, for undocumented children. Um, the, the bill also addresses, um, our TAM population. That's our targeted adult Medica, uh, Medicaid population, which is a critical program in, uh, our world of homeless services. These are for individuals typically that have been chronically homeless and are also dealing with substance use disorders. It's a, a unique program that, um, we had, uh, actually pre uh, expansion. There are some changes, uh, in hr, one that'll be sunsetting, uh, components of that program. Those individuals will still be eligible for, uh, Medicaid under the expansion program. Uh, this also says that if, if the administration makes other changes that would allow the TAM program to continue that, uh, under the direction of the director of DHHS and some other, um, kind of qualifiers that they would, uh, apply to, uh, reinstate the program that we currently have due to its, uh, uh, strong success of helping people step out of homelessness and back into our community. So, um, that's the basics of the bill. Um, it's kind of the principle of act or be acted upon. Um, we're not changing the fundamentals of Medicaid expansion or changing the, the trigger law. We're simply changing the timeframe so the legislature can be in a position to do a thorough analysis based on changes made by Congress and then decide if we allow the trigger to, to, to take place or if we make the decision to make adjustments accordingly. So, um, I have to admit, uh, many people were kind of caught off guard by the, the speed at which HR one was passed and some of the provisions that were put in there. And, uh, I don't think when we, uh, originally set the, put the trigger law in place, we anticipated, um, you know, how that could impact Utah based on future congressional action. So that's the basics of the bill. Mr. Vice chair. Welcome, by the way, um, that will conclude my, uh, presentation. And, and, and I will say, I know there's a number of people in the room wanting to speak to the bill. Um, I guess we'll wait, we have a, still have a long agenda. Um, I'll, I'll leave it to the discretion of the vice chair as to, you know, how much public comment we hear. So that concludes my presentation. Thank you. Perfect.

No, it, it, it's we're that, that is staying the same. Some, some sections in the bill are moving around, just were, were cleaning up the section. And so some of the underlying sections appear to be new, aren't new, they're underlined because they were moved. So, uh, if you read anything about per capita caps, which caused some people some consternation, that is not new policy that is simply rearranging the section of the code.

Um, that that is not the intent. Okay. All right. Luckily, I'm gonna, uh, with the permission of the chair invite Stephanie please to, uh, to answer that question, Not with DHHS,

but, um, I mean, I don't think that part, Stephanie Burdick, um, I represent the Medicaid Coalition, a bunch of advocates that work on Medicaid. Um, this is not really like changing the income threshold. This is just like going back into code where we've authorized waivers such as targeted adult Medicaid as well as Medicaid expansion. And because this part is specifically addressing, you know, the component down, when you look at like line 60, or sorry, line 3 83, that's where it starts to kind of just make some changes, um, with regards to just like how we're financing all of this and like some other decisions that would have to be made, but it doesn't actually change income eligibility. It just kind of is going back into code where there's been changes to apply to waivers and under one of our previous waivers. I think that that's where the 95%, um, per, that's, I think, I believe that's where the 95% comes in, because that was a part of the targeted adult Medicaid waiver, is what I understand it to be. But again, if there's anything from DHHS that can comment, but we've always, Medicaid expansion has always been up to 133% of FPL. It's just that in this, it's just trying to align different parts of code to kind of reflect some of the changes. But it doesn't change income eligibility at all. Does that answer your question?

By, I, I can assure you that is not the intent of the bill and not what it's doing. Okay. And if that was the case, then that will be fixed, but that is, I, I think we're just conflating the 95 versus the 133, which is, are two different metrics. Okay,

Um, so yeah, go ahead and start if you would. Um, Stephanie, ick again, I'm just here, um, with the Protect Medicaid Coalition, we work with a number of advocates, consumers, providers, um, we've been working on, um, just how to make sure that our Medicaid program is fiscally responsible and has high quality, um, healthcare for those who need it. And really appreciate Representative Ellison, um, working on this bill and the department, um, and other Representative Dunnigan and others in the legislature who really helped us to make sure that our program is, um, fiscally sound and also improving health outcomes. We really appreciate targeted adult Medicaid, especially on those components in this bill because of the impacts it has on public safety. So many of our police departments and, um, you know, we have county jails that work with trying to get people on targeted adult Medicaid while they exit jail. And just, there's a lot of really critical components within that program that improve our public safety outcomes. And so we really appreciate, um, the flexibility that it allows state, the state to work with our federal partners in maintaining tam, um, as appropriate and just appreciate, again, representative Bison's work on this. Thanks to your time.

Time yours. Okay. Thank you very much. My name is Patrick Fleming and I'm the chair of the Policy Review Committee, which is, uh, under the Utah Behavioral Health Commission, which a legislature enabled two years ago. And that purpose of that commission is to advise you on behavioral health issues that are impacting the citizens of Utah. So I'm here representing a subcommittee which reviews all of the bills and we take positions on bills, but we've been working with a good sponsor all year on this bill. We think this is a very smart approach. It's a very prudent approach, and I think it, uh, really helps protect Utah against the volatility that we're seeing right now when it comes to federal Medicaid policy. Um, as Stephanie mentioned, um, the population that's served by Utah's Medicaid program are most, some of the most vulnerable people that we have in the state of Utah. And so this, this bill really allows us to have a safeguard for services for those individuals. This is actually one of the Behavioral Health Commission's priority bills for this year. So I just would urge you to support this and favorably it's smart policy for Utah. And I think the representative has done a wonderful job on this. He's included so many people in the process, and so it's been very well vetted. So, Mr. Chairman, that's my comment.

Good morning. Uh, my name's Adam Cohen. I'm the president and CEO of Odyssey House, and also a commissioner on the Utah Behavioral Health Commission. I'm speaking in support of the bill, and I thank the sponsor for, um, for, uh, sponsoring the bill. Uh, essentially what Representative Eliason said, it puts the, puts Utah's legislature in the driver's seat if federal, um, if the federal government changes any Medicaid policy, and it also preserve attempts to preserve an innovative Utah program that is working well for our lowest income homeless individuals. Thank you.

Hi, my name is Justine Case. Um, I'm a member of the Rare Disease Advisory Council. And, um, this is relevant to rare disease because many of us use Medicaid. And I always like to make sure to emphasize with policy makers, though I'm here representing rare diseases. When you put us all together, one in 10 Americans, one in 10 Utahans lives with rare diseases. I personally live with six of them in my body. There are 10 more in my family tree. Multiple of my colleagues within the Rare Disease Advisory Council are beneficiaries of Medicaid. And in my communities, broadly, parents need the Medicaid waivers to care for their very high needs, special needs. Children without Medicaid families end up being separated, institutionalized. And so I really appreciate Representative Ellison being proactive, getting in front of this to ensure that the existing Medicaid services that our community relies on won't be interrupted, should we have a disruption to the way that we're funding. So thank you very much for the representative for planning for this, and ensuring that Utah's families that count on this to take care of the, their own children will be cared for and maintain the, the services they presently have. Thank you.

I have an answer to your question. Okay. Please. Um, the line that you're referring to, 360 6, that was from a prior waiver request language, um, in, in Utah, wanted to cover people up to a hundred percent of FPL. And then there's a 5%, uh, income disregard. So it's really the 95% CMS wouldn't approve that. Um, we, uh, under expansion have to cover people up to 130% of FPL, um, with a 5% income disregard. Then that's the 1 33. So this is just bringing the old waiver language in compliance with what CMS approved for a prior waiver.

Is, I'm sorry, is there, is there a sub or were Nope, it was sub in rules. It was Something rules.

So I would like a motion, make a motion that we approve HB one 15 second sub, Uh, HB 15 Oh h HP 15, sorry, second sub. There were a lot of ones there with a payroll recommendation.

No, this is a really technical bill, something that needs to be done,

Uh, th Thank you, Juab. Just in some, because I know, uh, Representative Kyle came in just, uh, late probably for another committee. This does not expand Medicaid. This simply puts Utah in the driver's seat, uh, based on potential decisions that Congress may make, I'm told will likely make. And, uh, important to note, our program is very financially sound with, uh, nearly a third of a billion dollars in reserves, which will grow with the disenrollment. That's going to happen. The only thing this bill will automatically do is make sure we have enough time to analyze changes and automatically Sunset the, uh, the program for undocumented children, if that, uh, potentially trips the waiver based on federal action. So, um, that's my presentation or my, that's my conclusion, Mr. Chair.

Yeah, sorry, I just had, I was looking for the fiscal note. I can't find it on here. Is

There, there is, uh, an original fiscal note for the bill that said zero. Um, the, the intricacy of, uh, having it subbed in rules, the other fiscal note should be out today. I'm told that that will, this will not be a fiscal note bill from those that are generating it, because we're not adding or subtracting to that. So, um, the, the subsequent fiscal note from the sub will be out today. Okay.

Uh, that's what I'm expecting it to be. If it's, if it's anything different, I will declare that on the floor if it makes it that far.

Uh, thank you. And I just wanna make sure the committee registered my I vote on that last bill. 'cause I did say yes from the back row, and then I realized, what am I doing? So not like c Creatures of habit. Yes. Okay. Um, this, uh, if you look at the bill number HB 15, it's a very low numbered bill. Uh, it was an inter interim bill that was unanimous. We've actually dialed it back from what it was. Uh, in the interim, it's a very, very simple bill. Let me just explain it. With the passage of HR one in the US Congress, otherwise known as the Big Beautiful Bill, we realized that if that bill, the first version would've passed, the, the house version would've ultimately been the bill that passed. Uh, our, uh, expansion Medicaid program would've Sunset potentially on June, well, on July 1st of this past year. Ultimately, some of those triggers, uh, were changed. And so it didn't put us at risk, but it, it did raise the question, do we want to be proactive to address potential changes by Congress or do we want to be reactive? So during the interim committee, we worked through that and again, have made some additional changes, worked with Senator Escamilla on one of the things that could have triggered it. Again, these are things that are outside of our control. We're just trying to be proactive to say, if it happens, what should we do? So one thing, the first thing it does is it says, instead of just sunsetting on July 1st, it kind of gave us this 12 month window. If Congress does something that pulls our trigger law, now, it just adjusts that timeframe. So it's still a 12 month period, but that period ends at the, the day after a legislative session. So that would mean that the legislature would have at least one session to address any changes. So, for instance, during interim, they said fiscal analysis did analysis as we could go down to 85% fmap and still be fine. This bill does not change the percentage for the trigger. It's still at 90%, but let's just say they reduced 85%. It would give us time like we did during interim to look at our budget and say, do we have enough funds? Last I checked, there was like 342 million in the a c expansion account. Pretty big buffer. Um, another thing that was in HR one is said that you will trigger our trigger law would've been pulled if, um, you have any program that covers undocumented children. This is when I worked with Center Escamia on this. Simply says, if they do that and it puts the entire program at risk, that component would Sunset versus having everything Sunset. Um, then one program that we've had for many years preceding, uh, the a CA expansion was the tam, the targeted Adult Medicaid program, which has been extremely helpful for individuals that are chronically homeless, have a substance use disorder, um, that is Sunset. This bill simply says if, uh, CMS or the administration indicates that some of the provisions that we have benefited from are allowable. That under the, at the, uh, gives our DHHS director the authority upon certain things happening to apply for a waiver to restore that benefit that the legislature put in place and was only taken away because of HR one. Um, the bill has a zero fiscal note. Um, I think that, oh, it also, uh, repeals a bunch of kind of outdated language when we were looking at different waivers prior to expansion. Uh, does move one section of code around so it appears underlined. Even though the per capita cap stuff is not new in this bill, it's just being moved around. So that's why it's underlined to Assange. Any concerns about that? So, uh, Mr. Chair, that's the basics of what it does. It's basically kind of act or be acted upon. Let's give ourselves time to examine, you know, what this would mean for Utahans if Congress does something to trick a trip, our trigger law, and just allow us to be in the driver's seat. So that concludes my presentation, Mr. Chair. Thank you. Bring it back to the committee for clarifying questions.

Good afternoon, committee members. My name is Stephanie Ick, and I'm here to represent the Protect Medicaid Utah Coalition. Um, we're a coalition of a variety of stakeholders, healthcare organizations, um, consumer advocates and advocacy organizations, behavioral health, et cetera. And just wanted to thank Representative Eliason for his work on this bill. Um, for those of you who aren't aware, uh, targeted adult Medicaid is turning 10 years old this year. Um, and it's helped provide a lot of, um, opportunities for people to get into recovery and get, um, access to opportunities and, uh, safety and housing. Um, and so we're so grateful for the program and grateful for all of the benefits that it's provided to the help and safety of Utahns. And appreciate the bill to be able to provide flexibility to our state to be able to continue that program, um, as permitted by the federal government. So, uh, we support this bill. Thank you.

Thank you Mr. Pr. Uh, Mr. Chair, make a motion that we favorably recommend second substitute HB 15 to the Senate floor.

I will waive. Thank you.

Thank you. To the sponsor. I'm Actually feel like I'm in Vegas and I'm willing to put all my chips on consent because otherwise, with the way the sift works, um, I could just, uh, die on the Hillary step. But the analogy that I use really didn't matter adverse, if you know what that is. So there again, zero fiscal note. Uh, all along the process, it's been unanimous. Interim session minus one vote. There's always one. Um, so anyway, that, yes, I strongly support that. Thank you, Mr. Chair.

Meeting clerk Second substitute house bill 15 Medicaid amendments by representative Stevie Sen. This bill was heard in revenue and taxation vote of 8 0 3.

Thank you Mr. Speaker. Speaker Pro tem. Uh, this was an interim bill, uh, with, uh, had unanimous support coming out of interim. We've made some additional changes to it. In the meantime, it's actually a very simple bill with a zero fiscal note. Uh, with the passage of the big beautiful Bill R one in Congress. It, uh, brought to light some potential issues with Medicaid, uh, expansion population in Utah. Uh, so this bill makes some, some minor adjustments to the process by which we would unwind Medicaid if Utah's trigger law is, uh, uh, triggered. So, uh, currently our trigger law would say if certain if we drop below the 90% fmap, then it would, uh, they'd begin disenrollment on JA July 1st. We realized that HR one almost passed at the end of June last year. And if that would've happened, it would've kind of caught us by surprise, even though we would've, uh, very likely had sufficient funds in the account to continue the program on. Uh, but it would've just automatically Sunset. So this modifies kind of the one year window to be aligned with the legislative session. So technically it could Sunset sooner. Uh, the, the period now, instead of July 1st is the day after the legislative session. So it's kind of the principle act or be acted upon. This would put the legislature into position to be in session, um, uh, at least one time, uh, if the trigger law is pulled. So that's just kind of changing that timeframe a little bit. It also requires the Department of Health, new Human Services, uh, to, uh, do analysis if the trigger law is pulled to come back with, uh, an analysis of what that means for Utah. We actually did that as, uh, a brief analysis as part of the interim, uh, bill that we looked at. And the fiscal analyst showed that we could easily go down to an 85% fmap if needed. This bill does not change the trigger below the 90%. Um, but it does require that if, uh, Congress makes changes that we would analyze it from a fiscal perspective. Currently there's about 342 million in the, uh, expansion account. So the sales tax that's coming into the current, uh, program is way more than sufficient for the cost of the program. Additionally, with the passage of HR one about estimates are maybe 27 to 30% of the current population will be dis-enrolled with the, uh, coming work requirement that will be in place. So that will create even more funding. Another thing this bill does is if Congress, uh, like they had contemplated in hr, one says that if you've expanded Medicaid to any undocumented population, your entire expansion program Sunset. Where Utah has done that, albeit not with Medicaid dollars, uh, this bill says we'll just automatically Sunset that program if that, uh, happens to be a potential trigger for a trigger law. The, the last thing it does, Mr. Speaker Pro Tem was a, a bill you sponsored many years ago, uh, related to the targeted adult Medicaid population. Changes were made, uh, with an R one affecting that program. This simply says that if CMS and upon the discretion of the director of DHHS sees that some of those provisions, uh, are available, that they would apply for apply to CMS for a waiver to restore some of those changes for the program that have been a tremendous benefit for those that are homeless and, uh, often criminally involved. Um, so that's basically what the bill does. Mr. Speaker pro tem, again, zero fiscal note. Basically just putting the legislature in the driver's seat if Congress makes additional changes to the expansion program and proactively thinking through some of the changes we would make, uh, if Congress does make additional changes. Thank you Mr. Speaker Pro tem.

The la the last thing I'll say, it actually repeals more code than it adds. So there's there, there's that too. We take a lot of old waiver language out. Thank you Mr. Speaker. Pro tem.

Yes, this is a bill that we worked on in the off season, but essentially as the federal budget changes and it may, they may occasionally drop down their allocation of the state of Utah or increase them. This is what gives the flexibility to the state of Utah to then adjust their budgets accordingly. If there's grant programs that's been associated with federal grants, then we also adjust those down. And that is the bill.

Senator Vickers. Baldry Aye. Lewin Aye. Brammer. Aye. Bus Fillmore es es Camilla as aye. Fillmore Aye. Rover Harper. Kinins Ipson Johnson. Aye. Juab McKay Mikel Milner Musselman Owens pitcher Plum Rebi Sandal Stevenson Stratton Vickers Weer Aye. Wilson. Aye. Winterton Ipson Ipson Aye.