Social Services Appropriations in the Era of Trump

Medicaid as Usual?

Utah’s Social Services Appropriations Subcommittee, chaired by Senator Alan Christensen (Republican – Ogden) began the year’s budget lock-down by rolling through the line items on the “Motions for Consideration,” totalling in the millions of dollars which are designed to care for Utah’s elderly (most of whom are on fixed incomes) and the economically disadvantaged. The uncertainty involved with this year’s budget effort is found in the newly formed administration and congress in Washington, D.C. and how they will finalize the money behind Medicare and Medicaid.

Even though the Utah legislators are working with fiscal year 2018, these uncertainties linger over the state which is legally bound to have a balanced budget and one that attempts to be fiscally responsible to its citizenry. The subcommittee’s approach? Business as usual and assume that the funds will be available from the federal government as always.

Chairman Christensen allowed his view about what constitutes “mandatory programs” to define the line by line-item effort, even though the definition originates with Health and Human Services in Washington and pertains to how they ascribe funds for Medicaid at the states’ level. Subjects dealing with Medicaid nursing home rates for increased hospice care costs are found in the Utah Department of Health’s budget. Shifting the line item on that from “Medicaid Mandatory Services,” to “Medicaid Optional Services,” adjusts for increased nursing home rates charged back to the state.

Additionally, housekeeping and accounting for Utah’s share in the effort to care for the underprivileged includes “moving federal funds from Medicaid Mandatory Services line item $5.3 million one-time in FY (Fiscal Year) 2017 and $11.3 million ongoing, beginning in FY 2018 to the Medicaid Expansion 2017 line item.” Since Utah hasn’t decided to expand Medicaid for those falling into the “donut hole” of non-coverage, this designation alludes to funds without the federal government waivers as Utah has applied for. Negotiations with the Obama administration were left incomplete and now new policies for Medicaid Expansion are awaiting articulation from the Trump administration.

What to Do?

Three physicians sit on the committee, Representative Raymond Ward, (Republican – Bountiful), Representative Ed Redd (Republican – Logan) and Senator Brian Shiozawa, MD (Republican – Salt Lake City) and their expertise contributes to the oversight required to adequately account for not only Utah’s funding, but also the dollars coming from Washington, D.C. which has reporting and stewardship requirements as well. Fiscal analysts working for the legislators were principally involved in explanations as to how much and where the federal dollars were to be accounted for, and as the fourth meeting of this committee in as many days, the effort’s cadence was maintained so that specific line items could be crossed-off as completed and agreed-to.

Fiscal analysts working for the legislators were principally involved in explanations as to how much and where the federal dollars were to be accounted for, and as the fourth meeting of this committee in as many days, the effort’s cadence was maintained so that specific line items could be crossed-off as completed and agreed-to.

With some uncertainty being evident and transmitted by a new administration in Washington, Representative Redd told UtahPoliticalCapitol that “What we’re doing relates to traditional Medicaid, so we’re not spending a lot of time trying to predict what happens at the federal level.”

Even so, depending on a raft of fiscally conservative ideas from the 115th Congress, Utah’s lawmakers and purse-holders may have some upcoming budget concerns that are not necessarily evident today. Topics under discussion in congress include vouchers and healthcare savings accounts and an entirely new approach to Medicaid in general. Critics are poised with data to be able to counter what they anticipate could be extreme revisions, but for now, it’s business as usual for Utah’s Department of Health and Department of Workforce Services.

The fifth and ongoing meeting of this appropriations subcommittee will convene Monday, January 30th at 8:00 AM.

Full audio of the interview with Representative Redd here.

Here

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.