The Bureaus of MCH/CSHCN (Title V) have a long-standing relationship with Medicaid (Title XIX) for the purpose of improving the health of women, infants and children and especially for CSHCN to ensure these vulnerable populations receive needed services and supports. Last year the two Divisions revised and updated the Interagency Agreement (IAA) to more adequately reflect the partnership and working relationship.

The IAA represents the overarching agreement between the two Divisions. Other specific program agreements are in place to ensure the MCH/CSHCN populations are receiving coordinated Title XIX and Title V care.

Program Outreach and Enrollment
CSHCN programs offer activities which include informing eligible/potentially eligible individuals about Medicaid, rural travel in support of Medicaid activities, referring, coordinating and monitoring the delivery of Medicaid services, and activities which improve coordination of care and delivery of services.

The list below provides some of the specific activities CSHCN performs for Medicaid enrollees.

The CSHCN Bureau collaboration includes regular meetings with Medicaid to discuss the variety of CSHCN issues, coverage, needs, and improvements to service and care.

Historically, CSHCN has primarily coordinated and collaborated with Medicaid to ensure services and funding for Title V populations. Medicaid and MCH/CSHCN have opened communications to improve collaboration among all Title V programs for their relative populations.

The Medicaid program provides matching funding to State dollars for several projects in the MCH/CSHCN Bureaus; the Pregnancy Risk Assessment Monitoring System (PRAMS), MotherToBaby, Fostering Healthy Children, Technology Dependent Waiver, Baby Watch Early Intervention, and WIC.

The MCH Integrated Services Program, Utah Birth Defect Network, Autism Systems, Hearing and Speech Programs, Baby Watch Early Intervention, Tech Dependent Waiver, and Fostering Healthy Children all provide administrative case management services, assistance, monitoring, coordination, referrals, and community education for Medicaid enrollees.

The programs provide extensive outreach throughout the state through many health fairs, agency and transition fairs, educational trainings, and one-on-one counseling sessions on obtaining services and how to be an advocate for your child.

The MCH/CSHCN Bureaus and Medicaid coordinate many committees that include stakeholders with diverse expertise who provide feedback and action to improve Utah’s health outcomes.

The MCH/CSHCN database systems do not have the capacity to collect and report on the percent of services delivered by MCOs and PCCMs. MCH/CSHCN are providing Medicaid reported numbers in the following areas: pregnant women, infants < 1 year of age, children 1-22 and CSHCN.

The Medically Complex Children’s Waiver (MCCW) serves children with medical complexities and complex medical conditions. The program is funded to serve approximately 530 children. Children enrolled in this program have access to unskilled routine and skilled nursing respite services, financial management services (to assist families self-directing respite care), as well as traditional Medicaid services.

The Technology Dependent Waiver, which was moved in early 2019 from DFHP to Medicaid for program administration, targets children who are dependent on certain types of technology and require skilled nursing or rehabilitation services. Individuals enrolled in the program have access to respite, family support, home health CNA, extended private duty nursing, in-home feeding therapy, and financial management services (to assist families self-directing respite care), as well as traditional Medicaid services.

Eligibility criteria for both programs:

Changes to the Utah Medicaid Program

Over the past several years, Utah has expanded Medicaid coverage to include more parents and childless adults. In recent years, Utah has increased Medicaid eligibility and benefits through state legislation, as well as a statewide ballot initiative.

Increased Coverage for Parents and “Targeted Adult Medicaid” (TAM)

At the direction of Governor Herbert and the legislature, Utah Medicaid expanded coverage in July 2017 to parents from 45% FPL to 60% FPL. Approximately 4,000 parents became eligible for coverage. In November 2017, CMS gave approval to expand coverage to adults without dependents living up to 5% FPL who are homeless, justice-involved, or have a substance use disorder and are receiving general assistance from the Department of Workforce Services. TAM enabled approximately 5,000 high-needs individuals to receive health care, including substance abuse and mental health treatment.

Medicaid and Family Planning Services

In 2018, the Legislature passed house bill 12 which directed Medicaid to unbundle immediate postpartum LARC insertion and pay for the devices separately from the inpatient hospital stay. The legislation also requires Medicaid to submit a waiver to CMS to expand family planning coverage to all women at or below 95% FPL.

Medicaid and Dental Coverage

Utah has also recently expanded dental coverage to more adults. Over the course of the 2018 and 2019 Legislative Sessions, the Governor and Legislature instituted Medicaid dental coverage for the TAM populations, older adults and disabled individuals. Medicaid does not provide dental benefits to parent/ caretakers or the majority of individuals without children. Children and pregnant women enrolled in Medicaid have dental benefits.

Medicaid Expansion

In November 2018, Proposition 3 passed in Utah. The ballot initiative directed the UDOH to expand Medicaid up to 138% FPL and receive the ACA federal enhanced matching rate. An estimated 150,000 individuals would become eligible for Medicaid coverage. Proposition 3 was slated to go into effect on 4/1/19.

On 2/11/19, Governor Herbert signed Senate Bill (S.B.) 96 (2019 Legislative Session) into law. This bill replaced Proposition 3 (2018 General Election). It anticipated 70- 90,000 individuals would become eligible for Medicaid by directing the UDOH to do the following:

Under S.B. 96, adults with incomes between 101- 138% FPL would be eligible for the ACA health care exchange, when the 2019 Open Enrollment period begins. Utah requested a special enrollment period for individuals who missed the 2018 Open Enrollment because they anticipated full Medicaid expansion up to 138%.  However, Utah’s request was denied by CMS. In addition, S.B. 96 also superseded House Bill 12 from the 2018 Legislative Session, as enhanced family planning services are covered under the partial expansion.

In accordance with S.B. 96, on 4/1/19, Utah expanded Medicaid coverage to adults who earn up to 100% FPL. The expansion covered parents/caretakers and adults without children. Utah receives its regular federal match rate to pay for the expansion. The federal government covers approximately 70% of the costs associated with caring for these newly eligible adults, with the state covering the remaining 30%. To date, more than 33,000 Utah adults have been enrolled in the expanded Medicaid program.

In July of 2019, CMS gave notice to Utah that it would reject the request for a partial expansion with the enhanced federal matching rate, or the “Per Capita Cap” waiver proposal. Utah is now preparing the “fallback” waiver plan, which will expand Medicaid up to 138% FPL, and will request that CMS approve additional provisions for the expansion population including a work requirement and ability to limit enrollment. The “fallback” waiver is expected to be released in mid-October and earliest implementation date would be January 2020.

As Utah prepares the “fallback” waiver, Medicaid coverage for adults and parents up to 100% FPL remains open for enrollment. Fewer individuals have enrolled than projected. The UDOH is planning to invest in an outreach program to help people learn about expansion.