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CMS Approves Medicaid Work Requirements, Spending Cap in Utah

The Centers for Medicare & Medicaid Services (CMS) approved Utah’s Section 1115 demonstration waiver to expand Medicaid to adults below the federal poverty level (FPL); the plan institutes work requirements and caps spending.

Utah is the first state to receive CMS approval to expand Medicaid only to individuals at or below the FPL. The Affordable Care Act gives states the option of expanding coverage up to 138 percent FPL. Because of this unusual structure, Utah will have to apply for a separate waiver from CMS to receive enhanced federal matching funds for the expansion population.

The state also is the first to implement a spending cap on the program, closing enrollment in the expansion population if projected costs for that group exceed state expectations.

Utah joins a growing list of states that have received approval to implement work and community engagement requirements for adults in the expansion population. The work requirements exempt certain groups, including:

  • pregnant beneficiaries and those 60 days postpartum;
  • primary caregivers for a family member under six;
  • members of federally recognized tribes;
  • individuals receiving unemployment insurance benefits;
  • individuals receiving treatment for substance use disorder;
  • individuals already exempt from or in compliance with work requirements through other federal programs;
  • participants in state refugee employment services;
  • individuals deemed physically or mentally unable to meet the requirements;
  • caregivers for a person with a disability;
  • students enrolled at least part-time in school, college, or university or vocational training; and
  • state family employment program recipients.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.

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