Trump Wants States to Experiment With Medicaid — Up to a Point

After a series of zigzags, Utah is about to expand Medicaid under the Affordable Care Act. At least 10 red states have done the same, but Utah’s experience may be a bellwether showing how far the Trump administration will let states go in customizing Medicaid, the joint federal-state health care program for the poor.

Utah voters approved Medicaid expansion last November, by a 53% to 47% margin. But after the state’s Republican-dominated legislature convened in January, it scaled back the voter-approved measure. Instead of covering childless adults making up to 138% of the federal poverty level — the standard in the ACA and the ballot initiative — Utah lawmakers wanted to cover only those making up to 100% of the poverty level.

Legislators also wanted to add a work requirement — even though courts have thwarted that in other states. They wanted Utah to “lock out” beneficiaries who intentionally received services to which they weren’t entitled — and to allow state Medicaid officials to remove them without a court finding. And they wanted Utah to be able to cap enrollment if it ran into budget problems.

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