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With the talk about Medicaid expansion taking up all the oxygen on Utah's Capitol Hill, there's a new proposal to overhaul Utah's existing Medicaid system.

Sen. Daniel Hemmert, R-Orem, wants to take a two-pronged approach to Utah's Medicaid program. SB172 directs the Department of Health to ask the Trump administration to give Utah a block grant, which the state would then use to administer its own Medicaid program outside of the feds. 

Failing that, the bill pushes for some changes and innovations from the Health Department.

Hemmert knows a block grant is probably a pipe dream.

"I hope it would happen, but I think it's a very high hurdle," says Hemmert. "The other thought is what can we do within Medicaid to innovate there."

Hemmert is adamant that he's not trying to find a way to cut benefits for existing recipients. However, he does think there's room for some changes.

First, and perhaps most controversial, he wants to take advantage of direction from the Trump administration to implement work requirements for some recipients. The work condition would not apply to children, the elderly, pregnant women or those who are disabled.

"We already have a work requirement with Operation Rio Grande," says Hemmert. "We need to see what makes sense. This would apply to a very small population of those who are already part of the program. We should find a way to make Medicaid as a stepping stone to be in a position financially where they don't need it anymore."

Another part of his proposal that may cause some controversy is possibly establishing health savings accounts for recipients. Those accounts typically hold tax-free money to help defray the costs of healthcare, but opponents of HSA's say accountholders might hold back the money that is accumulated instead of spending it.

Hemmert wants the Health Department to look into the possibility as a way to help Medicaid recipients have some money to help them transition off the program.

"What we're saying is let's figure out a way that would get savings monies for healthcare into the hands of Medicaid recipients," he said. 

The third part of Hemmert's proposal would establish an advisory board to help the department prioritize Medicaid programs in case there's an economic downturn.

"If the economy turns south, then the Medicaid ranks get larger," says Hemmert. "This would allow us to figure out what our highest priorities for Medicaid spending would be instead of implementing an across the board cut."

The advisory board would consist of "medical professionals, consumers, and health insurers" to make decisions on that priority spending.

Hemmert says Oregon asked for and received, a similar waiver from the federal government allowing them to prioritize Medicaid. 

"If you're trying to manage scarce dollars, it gives them the discretion to prioritize money so that the neediest among us don't lose services in an economic downturn," he explained.

Hemmert acknowledges every one of these proposals is 100-percent dependent on Utah applying for, and getting, a waiver from the Trump administration to implement them. 

Hemmert's proposal has nothing to do with the 2018 ballot initiative that would have Utah accept full Medicaid expansion to give medical coverage to the neediest Utahns who are at up to 138-percent of the federal poverty level. It also would have no bearing on Rep. Robert Spendlove's smaller Medicaid expansion proposal, that calls for spending caps and a work requirement.

The bill also makes a change to retroactive Medicaid payments. Previously, hospitals could retroactively bill three months worth of care for Medicaid. Hemmert wants to reduce that to two months.

If the bill passes, the Utah Department of Health would have until February 1, 2019, to apply for waivers from the Trump administration and implement the programs that are approved.