DAR File No. 43797

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-311-6

Household Composition and Income Provisions

Notice of Proposed Rule

(Amendment)

DAR File No.: 43797
Filed: 06/13/2019 09:27:48 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule filing is to update, in accordance with S.B. 96, passed in 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. (EDITOR'S NOTE: A corresponding 120-day (emergency) rule filing that is effective as of 05/07/2019 is under Filing No. 43707 in the June 1, 2019, issue of the Bulletin.)

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-415
• 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 proposed amendment to Rule R414-303 is under Filing No. 43796 and the proposed new rule filing for Rule R414-312 is under Filing No. 43798 in this issue, July 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 filing 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

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/31/2019

This rule may become effective on:

08/07/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$435,800,000	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$435,800,000	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$145,300,000	$0	$0
Non-Small Businesses	$145,200,000	$0	$0
Other Persons	$145,300,000	$0	$0
Total Fiscal Benefits:	$435,800 ,000	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

About 25,200 non-small business providers of Medicaid services may see a portion of annual revenue that totals $435,800,000 based on expansion to the Adult Medicaid population. Additionally, up to 90,000 individuals will see a share of out-of-pocket savings based on that amount.

 

 

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 8, 2018]2019

Authorizing, and Implemented or Interpreted Law: 26-18