Utah to request Medicaid waiver

Another proposal under development would allow Utah to convert current Medicaid managed care contracts into Accountable Care Organization-based contracts. 

This would tie Medicaid reimbursements to quality of care, instead of the current system of paying for each test and procedure.

Utah also wants the flexibility to give people who make too much to be eligible for traditional Medicaid the option of using government subsidies to buy private coverage.

"We think this introduces opportunities for the consumer to be in control," Herbert said.

And, he said, Utah wants the Centers for Medicare and Medicaid Services to approve a request made eight months ago allowing the state to communicate with Medicaid beneficiaries via e-mail. He estimated the savings at $6 million a year.

Michael Hales, director of the Utah Department of Health, told The Hill that the state is working with CMS to see what size sliding scale would be acceptable.

"It will definitely be a negotiation with the federal government," Hales said. "We haven't necessarily decided what the appropriate amounts would be."

Under federal law, Medicaid beneficiaries pay only $3 per doctor's visit.

The state also wants to be able to put aside Medicaid funds in a rainy day account so it can have savings in tough economic times and doesn't have to resort to service cuts, Hales said.

Herbert said Utah would also want the flexibility to shift people off the Medicaid rolls in bad economic times, but the state is not asking for such a waiver at this time. The healthcare reform law bars states from making their Medicaid eligibility requirement tougher than it was when the law was passed in 2010.

Arizona has asked for a waiver from the so-called maintenance of effort requirement, but the Department of Health and Human Services seems disinclined to grant it.

"We'll see how the Arizona approach goes," Hales said.