H.B. 471 Social Services Amendments: transcript

Awesome. Are we good? Yep. Okay. Thank you. Madam Chair and Committee House Bill 4 71 is a program or not a program a bill focused on aligning how Utah administers Medicaid and SNAP to federal code or, or, or federal law. Um, many of you're aware of, of HR one or the one big beautiful bill we are, are simply just aligning our state policy to that policy. These programs, um, both Medicaid and Snap, are essential, um, for many Utah families. And this bill is not about making, or this bill is about making sure that they remain sustainable, accurate, and trusted by the public. The legislation here does three main things and, and, and other things. But first, it improves, um, eligibility verification. That's through ensuring income residency identity citizenship or confirmed using reliable data sources. It promotes accountability, um, by implementing the work expectations for abled body adults, where federal law allows while maintaining exemptions. And it strengthens oversight by preventing duplicate multi-state enrollment, removing deceased enrollees, improving reporting, and creating clear standards. Um, it what there's some things that it does not do. This Bill does not remove eligibility categories. It does not reduce benefits for those who qualify. It simply ensures that the system is accurate and functioning as intended. Uh, strong, safe, safe. A strong safety net requires public confidence that it is administered responsibly and that it is what the bill does. Um, here, I'm happy to walk through anything specific if the committee has questions. Um, but really the intent and the purpose of this bill specifically is to align our state code to federal code as far as it goes with, with the one big beautiful Bill. HR one. Happy to answer any questions.

Oh, thank you, Madam Chair. So, we are obligated to follow federal law, whether or not we like it or think that it's a good idea. And it's, I mean, you know, our department's been working hard together with CMS to follow this law. Um, 'cause they're still making their rules, you know, we'll for sure follow the statute, but the rules are a little bit, take some work to put together. What will be different if we don't pass this bill? We'll,

Uh, thank you, Madam Chair. Um, one question I have is, I, I, you know, understand aligning with federal policy due to the supremacy clause. Um, I'm, I'm wondering for, for instance, the, um, retroactive eligibility is something that is often very helpful in a healthcare setting because you'll have somebody say, come into an emergency room, receive services, and then they would find out maybe they don't have coverage at that point for Medicaid, but they find out they're eligible, they enroll them. Um, if retroactive eligibility isn't an option, and again, again, if that's federal law, that's federal law, but my question is, if federal law changes, then with this bill in place, would we then be beholden to the, the, this higher or different standard, um, and be kind of be stuck with that? That could be at the detriment to some, you know, particularly healthcare providers then, that are like, well, you're eligible, but we can't retroactive. So then they just have to, to eat the cost of those services. Does that make sense? Yeah.

That's the case. Okay. I, I, I'm gonna support the bill, but maybe between moves outta committee, between floor time, we could just talk about maybe some particular language. I had a bill like this similar this morning, trying to align things with federal changes and anticipation of, you know, triggers that could happen. And so, you know, we can talk more offline. Thank you.

Yeah. And I would say in, in addition to that, initially when we put this together, we went past HR one, um, with the idea that we could, there was some room and opportunity to do things past what HR one was doing. Um, we, we've done a lot of work in finding some, some solutions in this, and a lot of our conversations have gone back to kind of something like this. What if things were to change? Does it make sense to go past HR one right now? Or does it make sense to just meet HR one where it's at? And, and kind of go from there.

and who you represent. Thanks. Um, good Afternoon, Um, here, um, on behalf of the Protect Medicaid Utah Coalition, um, the coalition is made up of healthcare advocates and consumers and beneficiaries and caregivers, local elected officials and providers. We've been focused on strengthening Utah's Medicaid program. We believe that a healthy and strong and responsible, um, Utah rely needs to have a good Medicaid program, right? So in order to make sure we're all safe and healthy, we believe that Medicaid needs to be effective at delivering high quality, affordable healthcare. Um, I wanna thank Representative Monson for his work on this bill. We had significant concerns with the original, and while we do, you know, maintain a few concerns on just codifying federal law, especially because so many of us worked so hard on trying to ensure that Congress did not in include the Medicaid cuts in HR one, we do appreciate his willingness to work with us and to listen to stakeholders and to take so much of our feedback into consideration in this first sub. Um, as a coalition, we may, we remain neutral with, you know, some, some concerns, um, about a few pieces. But we really do appreciate his willingness to work with us and how, um, and how much time he spent listening to our concerns, and again, integrating them into this first sub. And, uh, we hope that we can continue to work with him and other elected officials to strengthen Utah's Medicaid program. Thank you.

Hello, committee members, Elizabeth Garbe, vice President of Public Policy for United Way of Salt Lake. Um, and we are also neutral on sub one. And appreciate Representative Monson, um, work with us. Uh, we do have concerns with codifying federal law into state law. Um, it ties your hands when changes are made. It doesn't make you nimble. And that's the process of having the federal government pass laws and regulations coming down. So, um, we do share, share the concerns, and are part of the, the Protect Medicaid Coalition. So, just wanted to have that on the record. Thank you. Thank You.

Uh, thank you, Madam Chair. Um, my name is Nick Las Kle, and I'm the director of the State Health Reform Initiative at the Paragonah Health Institute. Uh, house Bill 4 71 sends a clear message that Utah is prioritizing the most vulnerable by strengthening Medicaid program integrity in the beehive state. Uh, though this legislation builds on key federal reforms enacted last summer, that help ensure the program is available only to those who are eligible. In doing so, it promotes responsible stewardship of finite taxpayer resources and helps preserve the program's long-term viability. Complete federal data on Medicaid payment errors in Utah are not available. However, national experience shows that approximately 73 3% of improper payments stem from eligibility errors, including payments made on behalf of individuals who are either ineligible or lack sufficient documentation to verify eligibility. These errors cause real harm by diverting limited resources away from the state's most vulnerable residents. House Bill 4 71 takes meaningful steps toward many of paragon's recommended best practices for program integrity. These include requiring eligibility documentation, rejecting self attestation for eligibility, and conducting routine checks against death and residency databases. The legislature could even build on these core reforms by reintroducing and tightening some of the provisions from the bill's original draft. These include provisions on redeterminations, additional cross checks against federal databases and tighter verification timelines. Together, these additional provisions would further strengthen the Medicaid program and better ensure that only eligible individuals are enrolled as costs continue to rise for state, for the state and its taxpayers. The long-term viability of Medicaid depends on reserving the program for those who are eligible. Uh, thank you, Madam Chair.

Thank you. Thank you, Madam Chair, I'd like to, uh, motion to amend, please.

I'd like to move that we adopt Amendment one in my name for, uh, HB for substitute HB 4 71.

Uh, yes. Madam Chair. And, and I appreciate all the work that the sponsor's gone in. It sounds like there's, uh, more work going on in the, in the works, and so I trust him a hundred percent to, uh, keep working this. Right. This was just something, uh, so if you look, uh, right past, uh, line 93 on the first substitute. So during the, during the interim, we talked in this committee about, um, exemptions for the community engagement rule when we were working with Department of Health and Human Services. One of the ones that we're talking about is individuals experiencing homelessness. Um, I think, uh, functionally, uh, with d and e, a lot of individuals who are experiencing unsheltered homelessness will be covered. This, make sure that, you know, take for example, what Representative Monson and I talked about is if there's a, you know, a mom fleeing domestic violence, she's at a domestic violence shelter, shelter. Those are the, those are the kinds of things that I'm hoping that this amendment can, can make sure that we catch and make sure that people aren't slipping through the cracks.

Yeah, I've spoken with the, the sponsor of the amendment and, and we've talked about it. I think he, he has a good idea on what we would be dealing with as far as this population. And I, I think it's a friendly amendment.

Um, I'll waive, appreciate the consideration from the sponsor. I know he's worked hard on this.

Yes, please Go Ahead. I'd like to make a motion that we favorably recommend first substitute HB 4 71 as amended to the full, uh, body of the House for, uh, vote.

Uh, just would echo what I said previously, that, uh, talking with Representative Monson, I know, uh, at anytime you're working on a, a Medicaid, uh, legislation, that's a tough challenge, um, because there's a lot of stakeholders and it's a issue, issue that matters to so many people. So, um, appreciate the hard work that's gone into us. It sounds like there's more, uh, work going on, uh, uh, with the groups that Representative Monson has been able to bring together, but, uh, appreciate his his work on this.

Yeah, I would just add that the really this bill is about responsible stewardship and, and of programs that Utah utahns depend on. Medicaid and SNAP are critical supports for families, seniors, people with disabilities, and those facing temporary hardships. Um, but for these programs to remain strong, they have to be administered accurately and transparently. This legislation, legislation strengthens verification, um, prevents duplicate enrollments, protects tax payer dollars, and reinforces the expectation that assistance programs help people move forward whenever possible. It does not remove eligibility, it ensures eligibility is real. It does not weaken the safety net, it protects it. Um, and I would just ask for your support. Thank you.

Thank you, Mr. Chair and Committee. Um, sorry. Alright. HB 4 71 is a, is a program, um, integrity bill focused on aligning Utah's law to federal law. As far as, um, SNAP and Medicaid goes, the, this piece of legislation does three main things. So first, it improves eligibility verification. Second, it promotes accountability by implementing work expectations for abled body adults where federal law allows. And third, it strengthens oversight by preventing duplicate, um, multi-state enrollment. It removes deceased enrollees promptly improving reporting and creates clear standards for retroactive eligibility. The reason why this is important is because, um, many of you have, have heard or or learned about the Rural Health transformation, um, program, which has given, created a, a grant program within the state. Now this is not a requirement of that program. Um, it is just, um, been indicated that there is a possibility that future funding will be based on what states are doing to implement policy. And this is one of those policies. This is federal. Um, this is going to happen regardless. But if we are, are making a good faith effort in, in providing policy that, um, aligns with this, we will improve our ability, in my opinion, to get more funding in the future. Um, I could go through the, the different things in in the bill for you, but I would be happy to answer any questions that you have directly related to it. The, the Medicaid and SNAP programs are critical for families. Um, they support families, they support seniors, they support people with disabilities and those facing temporary hardships. But for those programs to remain strong, for us to have sufficient funding to keep them going, they have to be administered accurately and transparently. This legislation strengthens verification, prevents the duplicate enrollment, protects tax taxpayer dollars. What it does is it, it does not remove eligibility. It simply ensures that eligibility is a real thing. That eligibility is, is a priority. It does not weaken the safety net for those that need this. It, it protects it. Um, and would conclude that and answer any questions that you'll have. Sure. I'll bring it back to committee for clarifying questions.

Oh, thank you Mr. Chair. Question to the sponsor. Um, so I'm looking at your bill. So you added an F right on 93 a line. So just to be clear, you're codifying, um, HR one mm-hmm. Which is thank you, uh, for doing that. And then, um, you do have you from your previous, from your original version, you did remove the reporting piece. Am I correct

From the Yes, yes. Your, your original version? Yes. Yes. I just wanna make sure This, so initially there was a, there was a lot that we, when this first came out, there was a lot that went past HR one. Correct. We've worked with lots of stakeholders to bring this back just to HR one.

And then I think the piece that you, that the f is, is that the homeless?

Yes. Um, that, that was added in committee in, in the House committee. Um, as long as the federal law allows that, then that's why that was kind of added in to, to help protect another population.

And, um, is this correct to say that the work requirement in this bill not only aligns with HR one, but also aligns to what the State Department of Health and Human Services plan was working on? Yes. Is that correct? Okay. Yes. Yeah.

Um, follow up question, Mr. Chair, if that's okay. Just, I wonder, but I may makes sense. And then, um, you're following federal law, which is for those programs is already in place. Mm-hmm. So they should be following that. Right. And then, um, just I guess my last question. What type of reporting, if any, is in your bill currently in this first substitute?

So currently, as far as reporting, um, all of it would follow the federal, federal law as far as what reporting is, is done. Um, anything that we have to do at a state level would be, would be done following the federal law.

Okay. Those are my questions. Thank you Mr. Chair.

Um, good afternoon committee members. I'm Stephanie Ick here with the Protect Medicaid Utah Coalition. We work on to strengthen Utah's Medicaid program. We know that a strong, um, Medicaid is a healthy and safe Utah. Um, we had significant concerns with the first version of the bill, but, um, Representative Monson was, um, really generous with his time and sat down and took, um, our comments and the comments of a variety of stakeholders. And while we, you know, we're kind of just neutral on this bill, because our coalition, we had significant concerns with HR one, as it does jeopardize the access to healthcare for millions of people across the country. However, we do remain neutral of this bill and generally just supportive of, um, representative Munson's time with us. Appreciate the amendments and the substitute and, um, it's, it's an improved version of this bill for sure. And, um, appreciate his time and continue to work towards strengthening Utah's Medicaid program.

Thank you Mr. Chair. I am, I appreciate, um, I know the, the good sponsor worked in making changes to put it where it is. I think this, uh, regardless of how we feel about HR one, it is federal law and we have to follow that law in order to make sure, um, we don't jeopardize our program. So I, I do appreciate that you were open to make those changes. And, and for that, I'll be asking my colleagues to move this bill favorably to the, to the Senate.

Thank you, Mr. Speaker. House Bill 4 71 is a, is a program integrity bill. This bill is focused on aligning how Utah administers Medicaid and snap. These programs are essential for, um, supporting families, supporting those that, um, have disabilities that are in, that are in need at some of the hardest times in their lives. This bill does a few different things. First, it improves eligibility verification, so ensuring income residency identity and citizenship are confirmed using reliable data sources, it does. Second, it promotes accountability by implementing work expectations for abled body adults where federal law allows. Third, it strengthens oversight by preventing duplicate multi-state enrollment, removing deceased enrollees and improving reporting through the department. This bill does not remove eligibility categories, and it does not reduce the benefits for those who qualify. It simply ensures that the system or that the the system is accurate and functioning as it should. It makes sure that, um, the public can trust the system that's being funded by the state and the federal government. Um, many of my colleagues have heard of, um, the one big beautiful Bill or HR one. What this bill does is it aligns state code to federal law. Um, if all of the things that are implemented in this bill are, are already required of the state by law, we are just making sure that we put it in our code to make sure that, um, we can keep those things going forward. There is also a, a piece that, um, two HR one, the, the Rural Health Transformation Funds that moving forward is, is going to be based on, um, how, how the states are, are using those funds and implementing policy. And so part of this is to, to signal that we are, um, interested and, and willing to make sure that we provide these programs for those that need them. And with that, Mr. Speaker, I would answer any questions.

Uh, thank you Mr. Speaker. Uh, motion to move amendment number two in my name.

Uh, yes. Th thank you. This is just a, a simple clarification, uh, clarifying that if an enroll, uh, uh, conducted eligibility determination for the recipient, and really, unless the enroll has already has continuous eligibility in accordance with state and federal law. So it's just, just clarifying if they're already eligible for the continuous enrollment, that that's part won't be applicable.

It's a friendly amendment. It, it doesn't change the intent of what we're trying to work on and, and still implements that federal law is what we intend to follow.

Colleagues, this bill is about responsible stewardship of programs that Utah's depend on. Medicaid and SNAP are critical supports for families, seniors, people with disability, and those facing temporary hardship. But for those programs to remain strong, they must be administered accurately and transparently. This legislation strengthens verification, prevents duplicate enrollment, protects taxpayer dollars, and reinforces the expectation that assistance programs help people move forward whenever possible. It does not remove eligibility. It ensures that eligibility is real. It does not weaken the safety net. It simply protects it. I respectfully ask for your support.

Thank you Mr. President. What we're doing in this bill is we're going, we went through, uh, HB one, uh, of the, uh, federal legislation and ensured that we aligned our state statute with the, the issues there. This helps us with the, uh, land squarely where it landed that level in our social service There. I'd be glad to answering questions. Thank you. Senator Stratton.

I will waive and move. First house bill 4 7 4 71 social evidence pass.

Vote. Senator Vickers Baldy Lewin Bra Brammer Bus Comore Escamilla Fillmore Grover Harper Kinins Ipson Johnson Aye. Juab McKay. Mikel Aye. Milner Musselman Owens Pitcher Plum Rebe Aye. Sandal Stevenson Aye. Stratton Aye. Vickers. Er Wilson Winterson. President Adams Aye. First substitute house Bill 7 4 71.