The imposition of spending limits for individual Medicaid recipients has been discussed in Washington policy circles for years and was offered in the White House’s recent FY 2020 budget proposal.  While deliberations on such a proposal have never advanced in a meaningful way, the state of Utah is doing more than talking about such an approach:  it has petitioned the Centers for Medicare & Medicaid Services for a Medicaid waiver that would enable it to introduce such a system in its state Medicaid program.

Under the state’s proposed Medicaid waiver, Utah asks the federal government to limit its own Medicaid contributions to a fix amount for each Medicaid enrollee – a per capita limit, as this approach has often been called.  Utah has joined this request with a proposal to expand its Medicaid program, as permitted under the Affordable Care Act – but to do so only for individuals earning up to 100 percent of the federal poverty level and not the 138 percent level authorized by the 2010 health care reform law.

While the request is still under consideration in Washington, state officials are reportedly optimistic:  they expect to begin enrolling new recipients on April 1.

NASH has long been concerned about any effort to impose artificial limits on state Medicaid spending; such limits could be especially harmful to private safety-net hospitals because they care for so many Medicaid patients.  NASH’s most recent expression of this concern can be found in its 2019 advocacy agenda.

Learn more about Utah’s effort to implement a policy that some in Washington have sought for years but that has failed to gain wide support in the Washington Post article “Utah is testing the Trump administration’s dream of limiting Medicaid spending.”