Add blog post: Utah HB 15 Medicaid expansion repeal analysis

app/src/data/posts/articles/utah-hb15-medicaid-expansion-repeal.md

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+Utah's [House Bill 15](https://le.utah.gov/~2026/bills/static/HB0015.html), sponsored by Rep. Steve Eliason (R-Salt Lake County) and Sen. Keith Grover (R-Utah County) in the 2026 legislative session, would repeal the state's Medicaid expansion if the federal matching rate (FMAP) drops below 85%. Currently, the federal government pays 90% of expansion Medicaid costs. This analysis models the scenario where expansion is repealed.
+
+## Background: Medicaid and the ACA expansion
+
+Medicaid is a joint federal-state program providing health coverage to low-income individuals. Before the Affordable Care Act (ACA), Medicaid primarily covered specific groups: children, pregnant women, parents with very low incomes, and people with disabilities. Non-disabled, non-elderly adults without children generally could not qualify, regardless of income.
+
+The ACA expanded Medicaid eligibility to all adults under 65 with household income at or below 138% of the Federal Poverty Level (FPL). The federal government initially covered 100% of expansion costs, phasing down to 90% by 2020—higher than the standard FMAP of about 70% for traditional Medicaid in Utah.
+
+HB 15 defines its own calculation for the effective federal matching rate and would repeal expansion if that rate falls below 85%, reflecting concerns that Congress could further reduce the enhanced FMAP and shift more costs to states.
+
+### Utah's Medicaid expansion history
+
+Utah voters approved Medicaid expansion via [Proposition 3](https://ballotpedia.org/Utah_Proposition_3,_Medicaid_Expansion_Initiative_(2018)) in November 2018, and full expansion took effect in 2020.[^1]
+
+[^1]: HB 15 would also repeal the 0.15% state sales tax that funds Utah's share of expansion costs. This analysis does not model the sales tax repeal.
+
+Utah also maintains separate Medicaid categories for specific populations:
+- **Parents/caretaker relatives**: Income limit of 46% FPL (~$10,200 for family of two)
+- **Children**: Covered through Medicaid up to 136% FPL, then CHIP up to 205% FPL
+- **Pregnant women**: Higher income limits with comprehensive coverage
+
+### 2027 Federal Poverty Levels
+
+This analysis uses projected 2027 FPL values, estimated by applying historical inflation trends to the 2024 FPL guidelines:
+
+| Household Size | 100% FPL | 138% FPL (Expansion Limit) |
+|----------------|----------|---------------------------|
+| 1 person | $16,334 | $22,541 |
+| 2 people | $22,138 | $30,550 |
+| 3 people | $27,942 | $38,560 |
+| 4 people | $33,746 | $46,569 |
+
+## Key findings
+
+For 2027, PolicyEngine estimates:
+
+- ~84,000 people would lose Medicaid enrollment
+- ~73,000 (86.5%) would fall into the "coverage gap" (not eligible for ACA subsidies)
+- ~11,000 (13.5%) would gain ACA Premium Tax Credit eligibility
+- Utah would save ~$73 million/year
+- Federal government would save ~$575 million/year (net of increased ACA costs)
+
+_[Use PolicyEngine](https://www.policyengine.org/us) to calculate the effect on your household._
+
+## Understanding the coverage gap
+
+The "coverage gap" refers to individuals whose earnings exceed traditional Medicaid limits but fall below the 100% FPL threshold where ACA marketplace subsidies begin. If expansion is repealed, adults in this range would not qualify for either program.
+
+## Single adult household
+
+Consider a single adult in Utah. Under current law, adults earning up to 138% FPL (~$22,500/year) qualify for Medicaid expansion, receiving $8,000 in annual benefits per the PolicyEngine model.
+
+At $12,000/year (75% FPL), this adult currently receives Medicaid coverage. Under HB 15, they would lose coverage entirely—a single childless adult has no other Medicaid eligibility pathway in Utah, and at 75% FPL they earn too little for ACA subsidies.
+
+At $18,000/year (110% FPL), that same adult could transition to ACA coverage, receiving premium tax credits worth $11,544. While the PTC amount exceeds the Medicaid benefit value, this reflects the higher cost of private insurance premiums compared to Medicaid's per-person cost to the government.
+
+**Table 1: Health Benefits for Single Adult in Utah (2027)**
+
+| Income | % FPL | Medicaid (Baseline) | Medicaid (Reform) | ACA PTC (Baseline) | ACA PTC (Reform) | Notes |
+|--------|-------|---------------------|-------------------|-------------------|------------------|-------|
+| $12,000 | 75% | $8,000 | $0 | $0 | $0 | Coverage gap |
+| $16,334 | 100% | $8,000 | $0 | $0 | $11,579 | FPL threshold |
+| $18,000 | 110% | $8,000 | $0 | $0 | $11,544 | ACA eligible |
+| $22,541 | 138% | $8,000 | $0 | $0 | $11,103 | Expansion limit |
+| $25,000 | 153% | $0 | $0 | $10,802 | $10,802 | Above expansion |
+
+The chart below shows how health benefits change across income levels for a single adult. Solid lines represent current law, while dotted lines show the reform scenario.
+
+**Figure 1: Health benefits for a single adult in Utah by income**
+<iframe src="https://policyengine.github.io/utah-hb15-charts/single-adult.html" width="100%" height="550" frameborder="0"></iframe>
+
+## Single parent with child
+
+For a single parent with one child, the FPL threshold is higher (~$22,100 for a family of two), meaning the coverage gap extends to higher income levels.
+
+Utah has a separate parent/caretaker Medicaid category with an income limit of 46% FPL (~$10,200 for a family of two). Under HB 15, very low-income parents would retain Medicaid through this category, though at a lower benefit level ($6,043 vs $8,000).
+
+A parent earning $12,000/year (54% FPL) would fall into the coverage gap under HB 15—above the parent Medicaid limit but below the ACA threshold. Their child remains covered through Medicaid at lower incomes, transitioning to CHIP at higher incomes.
+
+At higher incomes (above 100% FPL), parents can transition to ACA subsidies. Children remain on Medicaid up to about 136% FPL, then CHIP up to 205% FPL (about $46,000 for a family of two), after which they lose coverage.
+
+**Table 2: Health Benefits for Single Parent + Child in Utah (2027)**
+
+| Income | % FPL | Parent Medicaid (Baseline) | Parent Medicaid (Reform) | Child Medicaid/CHIP | ACA PTC (Baseline) | ACA PTC (Reform) | Notes |
+|--------|-------|---------------------------|-------------------------|---------------------|-------------------|------------------|-------|
+| $8,000 | 36% | $8,000 | $6,043 | $3,495 | $0 | $0 | Parent Medicaid (below 46% FPL) |
+| $12,000 | 54% | $8,000 | $0 | $3,495 | $0 | $0 | Coverage gap (above 46% FPL) |
+| $22,138 | 100% | $8,000 | $0 | $3,495 | $0 | $11,457 | FPL threshold |
+| $30,550 | 138% | $8,000 | $0 | $3,495 | $0 | $10,812 | Expansion limit |
+| $35,000 | 158% | $0 | $0 | $2,827 | $10,270 | $10,270 | Above expansion (CHIP) |
+
+The chart below shows how health benefits change across income levels for a single parent with one child. Very low-income parents retain some Medicaid coverage under the reform. The child transitions from Medicaid ($3,495) to CHIP ($2,827) at higher incomes, losing coverage entirely above 205% FPL (~$46,000).
+
+**Figure 2: Health benefits for a single parent with child in Utah by income**
+<iframe src="https://policyengine.github.io/utah-hb15-charts/parent-child.html" width="100%" height="550" frameborder="0"></iframe>
+
+## Statewide fiscal impact
+
+For tax year 2027, HB 15 would generate the following fiscal impacts (all figures represent spending changes, not revenue):
+
+| Category | Amount |
+|----------|--------|
+| Total Medicaid spending reduction | $734 million |
+| Federal share (90%) | $660 million |
+| State share (10%) | $73 million |
+| Increased federal ACA spending | $85 million |
+| **Net federal spending reduction** | **$575 million** |
+| **Net state spending reduction** | **$73 million** |
+
+## Who is affected?
+
+Of the ~84,000 people losing Medicaid enrollment:
+
+- **86.5% fall into the coverage gap**: These individuals earn below 100% FPL and would not qualify for ACA subsidies.
+
+- **13.5% can transition to ACA**: These individuals earn between 100-138% FPL and can obtain marketplace coverage with premium subsidies.
+
+Children's coverage is largely unaffected by HB 15—they remain eligible for Medicaid up to 136% FPL and CHIP up to 205% FPL regardless of the expansion repeal. However, children in households where a parent loses Medicaid may experience indirect effects if their parent forgoes care due to loss of coverage. Only adult coverage under the expansion category is directly affected.
+
+### Demographics of affected population
+
+The table below summarizes the demographic profile of those who would lose Medicaid coverage under HB 15.
+
+| Characteristic | All Affected | Coverage Gap | ACA Transition |
+|----------------|--------------|--------------|----------------|
+| Number of people | 84,000 | 73,000 | 11,000 |
+| Average age | 30 years | 30 years | 31 years |
+| Average household income | $49,400 | $50,200 | $44,500 |
+| Average FPL | 65% | 58% | 114% |
+
+The chart below shows the distribution of affected individuals by household income decile. Those in lower deciles are more likely to fall into the coverage gap, while those in higher deciles can transition to ACA coverage.
+
+**Figure 3: Affected population by household income decile**
+<iframe src="https://policyengine.github.io/utah-hb15-charts/income-distribution.html" width="100%" height="500" frameborder="0"></iframe>
+
+**Age distribution**: The affected population skews young—43% are young adults (18-25), and 33% are ages 26-34. The average age is 30 years.
+
+**Figure 4: Affected population by age group**
+<iframe src="https://policyengine.github.io/utah-hb15-charts/age-distribution.html" width="100%" height="500" frameborder="0"></iframe>
+
+## Conclusion
+
+Utah HB 15 creates a contingent repeal of Medicaid expansion that would take effect if federal matching drops below 85%. If enacted, the policy would reduce state Medicaid spending by ~$73 million annually. Approximately 73,000 adults earning below 100% FPL would lose coverage and would not qualify for ACA subsidies, while ~11,000 adults at 100-138% FPL could transition to ACA marketplace plans.
+
+PolicyEngine can help evaluate the impacts of reforms like this on diverse household compositions and state budgets.
+
+We invite you to explore our [additional analyses](https://www.policyengine.org/us/research) and use [PolicyEngine](https://www.policyengine.org/us) to calculate your own benefits or design custom policy reforms.

app/src/data/posts/posts.json

@@ -17,6 +17,15 @@
     "filename": "ri-governor-mckee-child-tax-credit.md",
     "image": "ri-governor-mckee-ctc.webp"
   },
+  {
+    "title": "Utah HB 15: Medicaid expansion repeal analysis",
+    "description": "If triggered, the bill would leave ~94,000 Utahns in the coverage gap while saving the state $99 million annually.",
+    "date": "2026-01-27",
+    "tags": ["us", "us-ut", "policy"],
+    "authors": ["daphne-hansell"],
+    "filename": "utah-hb15-medicaid-expansion-repeal.md",
+    "image": "ut-SB60.jpg"
+  },
   {
     "title": "Validating unemployment insurance estimates",
     "description": "PolicyEngine corrects CPS underreporting of UI benefits using quantile regression forests and reweighting, matching administrative totals within 2-4%.",