President Barack Obama's signature health overhaul goes into full effect in 2014 and will require sizeable investments from states, an expense that is not mentioned in Herbert's budget.
It contains no money for the law's now optional provision to expand Medicaid to cover more poor adults. In fact, as a percentage of state spending Medicaid drops in the governor's budget, from 8.4 percent in fiscal year 2013 to 7.9 percent in fiscal year 2014.
Herbert recommends $22 million in ongoing funds to cover 48,500 Utahns who are eligible now for Medicaid and haven't enrolled. They are expected to sign up after Jan. 1, 2014, when the health law requires virtually all Americans to have health coverage.
That money represents a re-investment of savings from a projected dip in Medicaid enrollment in 2013.
In short, say advocates for the poor, the governor is agreeing to fund what the state was already legally obligated to fund, leaving many families without affordable insurance options come January 2014.
"The ball is now in the Legislature's court to do the right thing," said Matt Slonaker, director of Medicaid Policy and Collaborations at the Utah Health Policy Project. "At the very least Utah should take the 100 percent federal funding for the first three years and try it out. Otherwise our federal tax dollars will flow to other states that choose to expand."
Unknown is whether Utah will bring its health exchange, Avenue H, into compliance with new federal standards. In advance of Friday's deadline to decide, Herbert this week asked Obama to accept Avenue H as meeting the "bare minimum" requirements of the law.
The governor's budget calls for $54,200 in ongoing money and $419,600 in one-time funds for the Web-based insurance shopping tool.
Herbert reiterated Wednesday he is confident Utah can do health reform better and more cheaply than the feds.
But Democrats fired back, saying the state's reforms have been a failure.
"We're not reducing costs, we're not [insuring] more people into the system," said state party Chairman and Sen.-elect Jim Dabakis. "To double down on what has been a failure by any standard is a huge mistake."
Other health spending highlights
Nearly $1 million to pay for a second year of credit monitoring for victims of a large health data breach last spring.
$3.6 million for treatment and screening services for developmentally disabled children.