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The state submitted its Medicaid expansion plan to the federal government Friday, but the wait for health care is still far from over for the 9,000 to 11,000 people it's projected to cover.
The federal government typically takes eight or nine months to look at these plans, and federal officials previously told the state they've never approved a plan with targeted populations like this one, said Nate Checketts, the Utah Department of Health's deputy director.
The feds assured state officials that didn't mean the plan was automatically doomed, just that "it's something new for them," Checketts said.
Utah's plan targets childless adults who are chronically homeless, involved in the justice system or in need of mental health or substance abuse treatment. It also expands coverage of low-income parents with dependent children previously not covered by Medicaid.
Sen. Luz Escamilla, D-Salt Lake City, suspects these restrictive groups might be a hang-up for the feds.
"That's probably where the feds will come back and say 'you excluded everyone, I'm not sure who you cover here.' " Escamilla said.
Escamilla was against the small-scale expansion, which passed this year after years of debate and protests. Initially estimated to expand coverage to about 16,000 people, the $100 million in federal and state dollars set aside for the plan now is estimated to cover 9,000 to 11,000 Utahns.
But in reality, the state could see more or fewer enrollees, Checketts said, because the federal government told legislators they could not set a strict cap on the dollar amount or the number of individuals served.
Should more people enroll, he added, the state would be obligated to serve them.
"Since we were given a fixed budget to work with, we wanted to be careful in creating these targeted groups," he said. "We didn't want to get more applicants than we budgeted for and then have to go back to the legislature and say" we need more money.
After the federal Centers for Medicare and Medicaid Services receives the state plan, it will conduct its own public comment period on the proposal. Checketts expects negotiations on the proposal to begin in August.
State health department officials hope to begin enrolling individuals Jan. 1, 2017, but Checketts admits that schedule is "optimistic."
Checketts said the federal government could approve some parts of the proposal while axing others.
Should it ax the homeless or criminal justice portions, Escamilla expects further expansion discussions will take place.
"Many of the groups who support this that may not, historically, have been in line with this policy supported it because of all the single adults who have never been covered before," she said. "If they don't cover them, I'm not sure how this is solving anything."
If the feds approve only portions of the proposal, Checketts said, department officials would sit down with policymakers, such as the governor and certain lawmakers, to discuss whether to move forward with a pared-down plan.
If they said no, Checketts said the state would drop the whole thing.
"We can back out," he said. "We're not bound ... to do whatever [the feds] accept."
When asked about a potentially pared-back plan, House Majority Leader Jim Dunnigan, R-Taylorsville, said he'll worry about that if it happens.
"It's still my hope and intent that (federal officials) will approve the plan submitted to them and until I see something different that's still my expectation," Dunnigan said.
Sen. Brian Shiozawa, R-Cottonwood Heights, said he thinks the state should move forward even if the state doesn't approve the full plan.
Even a fraction of the proposal "gives us that step forward," said Shiozawa, a doctor who previously sponsored a more generous, unsuccessful Medicaid expansion measure. "Let's do something."
Utah's recent public comment period garnered more than 130 remarks, many of which called for full Medicaid expansion.