DAR File No. 43707

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-311-6

Household Composition and Income Provisions

Notice of 120-Day (Emergency) Rule

DAR File No.: 43707
Filed: 05/07/2019 03:38:11 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to update, in accordance with S.B. 96 passed during the 2019 General Session, standards of income for Targeted Adult Medicaid (TAM).

Summary of the rule or change:

This amendment increases the federal poverty level (FPL) percentage to 5%, thus removing the income disregard for TAM members who are part the new Adult Expansion Group.

Emergency rule reason and justification:

Regular rulemaking procedures would cause an imminent budget reduction because of budget restraints or federal requirements; and place the agency in violation of federal or state law.

Justification: With recent federal approval of the Primary Care Network 1115 Demonstration Waiver, the Department of Health (Department) needs to implement provisions for Medicaid expansion, which began 04/01/2019. This provision implements the new income limit for TAM.

Statutory or constitutional authorization for this rule:

• Section 26-18-415
• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is an expected annual cost of $435,800,000 in which up to 90,000 individuals may become eligible for adult Medicaid coverage. This fiscal analysis also applies to the companion filings for Rules R414-303 and R414-312. (EDITOR'S NOTE: The 120-day (emergency) filing for Rule R414-303 is under Filing No. 43706 and the 120-day (emergency) filing for Rule R414-312 is under Filing No. 43708 in this issue, June 1, 2019, of the Bulletin.)

local governments:

There is no impact on local governments because they neither fund nor provide services under the Medicaid program. This fiscal analysis also applies to the companion filings for Rules R414-303 and R414-312.

small businesses:

Small businesses may see a share of revenue up to $435,800,000 with the expansion of adult Medicaid coverage, in which up to 90,000 individuals may become eligible. This fiscal analysis also applies to the companion filings for Rules R414-303 and R414-312.

persons other than small businesses, businesses, or local governmental entities:

Medicaid providers may see a share of revenue up to $435,800,000 with the expansion of adult Medicaid coverage, and up to 90,000 individuals will see a share of out-of-pocket savings based on that amount. This fiscal analysis also applies to the companion filings for Rules R414-303 and R414-312.

Compliance costs for affected persons:

There are no compliance costs because this rule can only result in increased revenue and out-of-pocket savings. This fiscal analysis also applies to the companion filings for Rules R414-303 and R414-312.

Comments by the department head on the fiscal impact the rule may have on businesses:

Businesses will see a share of revenue through Medicaid expansion to a larger group of adults.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

This rule is effective on:

05/07/2019

Authorized by:

Joseph Miner, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-311. Targeted Adult Medicaid.

R414-311-6. Household Composition and Income Provisions.

(1) The eligibility agency shall use the provisions of Section R414-304-5 to determine household composition and countable income.

(2) Section R414-304-12 applies to the budgeting of income through the Modified Adjusted Gross Income (MAGI) methodology.

(3) For an individual to be eligible to enroll in Targeted Adult Medicaid, the individual must have [zero ]countable income at or below 5% of the federal poverty level (FPL).

 

KEY: Medicaid, Targeted Adult Medicaid, eligibility

Date of Enactment or Last Substantive Amendment: May 7, 2019

Authorizing, and Implemented or Interpreted Law: 26-18