Utah’s Medicaid Expansion and the COVID-19 Pandemic

During the 2018 midterm elections, Utah voters approved full Medicaid expansion under the Affordable Care Act for individuals with incomes up to 138% of the federal poverty level (FPL). Utah legislators then applied to the federal Centers for Medicare and Medicaid Services (CMS) for a partial expansion for individuals with incomes up to 100% of the FPL. In December 2019, CMS approved an expansion up to 138% of the FPL in Utah, starting on January 1, 2020. The Medicaid expansion coincided with the COVID-19 pandemic, which also impacted Medicaid enrollment and retention.

The overarching goals of this analysis are to generate evidence for Utah legislators and healthcare officials regarding health insurance enrollment and characteristics of Medicaid and non-Medicaid insured persons, and to assess clinical quality and receipt of high-value care for these populations.

To achieve these goals, we will use two time periods: 1) pre-Medicaid expansion/pre-COVID (January 1, 2019-December 31, 2019) and 2) post-Medicaid expansion/during-COVID (January 1, 2020-June 31, 2021).

Our research objectives are three-fold:

(1) Using the Utah all payer claims database and Utah Population Database, assess the increase in Medicaid enrollment during the COVID-19 pandemic, the type of coverage individuals had prior to enrolling in Medicaid, and whether the increase in enrollment during the pandemic was driven by new enrollment versus retaining existing enrollees due to the Maintenance of Effort provision in place during the Public Health Emergency.

(2) Compare the demographic and clinical characteristics of the newly enrolled adult Medicaid population to the adult population previously enrolled in Medicaid.

(3) Assess the clinical quality of the care received by the newly enrolled adult Medicaid population and determine whether it is high-value.

Current Status

2025-01-21
Utah’s Medicaid expansion was implemented in January 2020, almost aligning with the onset of the COVID-19 pandemic in the U.S. This timing provided a unique opportunity to understand the Utah experience and examine the role of Medicaid during a public health emergency. We assessed the clinical and demographic characteristics, coverage duration, and preventive care received by new Medicaid enrollees in 2020, as compared to previous enrollees. We found that new Medicaid enrollees were generally younger, healthier, and more predominantly male than previous Medicaid enrollees. Preventive quality measure rates were sometimes better for new enrollees and sometimes better for previous enrollees, and months of enrollment were higher for previous enrollees. The Utah Medicaid program was able to provide preventive services during a public health crisis and during Medicaid expansion to its enrollees.