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House advances substitute Access Utah plan for coverage gap but postpones final action
Summary
The Utah House replaced HB401 with a substitute creating a defined-contribution "Access Utah" path to address the Medicaid coverage gap and charged the Health System Reform Task Force to continue negotiations with state and federal partners; after extended debate over behavioral-health coverage, the floor circled the bill for later consideration.
The Utah House on March 6 advanced a substitute to House Bill 401, dubbed the "Access Utah" plan, that would create a defined-contribution pathway intended to reduce the state’s Medicaid coverage gap. Sponsor Representative Dunnegan said the measure charges the Health System Reform Task Force to continue talks with the governor, the Department of Health and the Centers for Medicare & Medicaid Services to seek a workable approach.
Representative Dunnegan said the substitute provides "a path forward" if the House, Senate, governor and federal government can reach agreement; otherwise, it keeps the task force working toward a solution. He described the measure as "a House proposal to provide coverage for people in the coverage gap between 0 and 100 percent of poverty." The substitute contains no direct ongoing funding but would allow defined contributions or employer‑sponsored coverage to be used where available.
Supporters urged the chamber to preserve a flexible route to coverage. Representative Sampey said the substitute allows work to continue even if some federal waiver options are denied, calling that better than "a percentage of nothing." Representative Paulson, who said he favors careful fiscal stewardship, cautioned the plan could cost the state, saying "it costs $35,000,000 in state funds each year," and urged members to examine comparative plans and spreadsheets provided to members.
Opponents and several questioners pressed the sponsor on behavioral‑health coverage and protections for the medically frail. Representative Chavez Houck sought to know whether the proposal would cover childless adults and how behavioral‑health services — particularly in Salt Lake County — would be handled. Dunnegan said the substitute would permit enrollment in employer plans with state help or in a Primary Care Network (PCN) that could be modified to better serve behavioral‑health needs; he also said the bill plugs in the federal definition of "medically frail." Members repeatedly raised South Dakota’s recent waiver experience; Dunnegan summarized that South Dakota pursued a similar partial expansion and later learned key flexibilities were not granted by CMS.
Procedurally, a motion for the previous question (to cut off debate) failed after the chamber experienced technical voting problems. Later, Representative Johnny Anderson moved to "circle" the bill — a procedural postponement — and the House carried that motion, postponing final action so the task force and sponsors can continue discussions.
The House did not adopt final implementing language for PCN benefit design, nor did it appropriate long‑term funding; supporters framed the substitution as a compromise that preserves options while task‑force work continues. With the bill circled, the sponsor and task force retain authority to negotiate next steps and to return the matter to the floor when ready.
