Advocate’s Guide to Fighting Medicaid Caps

image of a sturdy bridge labeled "prop 3" and a broken bridge labeled "pending waiver"- captioned "the proposed per capita cap would do nothing to protect Utah from the rising flood waters of health care costs and puts the entire Medicaid program and all Medicaid recipients at risk
It is time to get involved and speak up against harmful plans to cap Utah’s Medicaid program!


What is a per capita cap?
The per capita cap is the key feature of the second waiver under the SB96 partial Medicaid expansion.
It is a way of cutting Medicaid that shifts the financial risk of rising health care costs from the federal government to the state by allocating a limited amount of federal dollars for the state’s Medicaid program instead of the current open-ended match rate system.


Why is it dangerous?
  • Under a per capita cap structure, the state receives a limited amount of federal dollars, and in exchange, receives permission to make cuts to Medicaid that are normally not allowable. This means that the only flexibility gained, is the flexibility to cut services and eligibility to Medicaid.
  • Per capita caps make it harder to provide services during emergencies or economic recessions – when our community needs help the most.
  • These caps are problematic on the first day, but those problems will compound over time as the growth of the cap fails to keep up with actual rising costs.
  • Due to the limited nature of the arrangement, there has never been, and never will be a per capita cap deal that is as good as the current match rate system, which allows open-ended flexibility and risk-sharing.
  • Instead of addressing the root causes behind rising health care costs, these caps will only cut Medicaid spending by cutting vulnerable people off their insurance, or cutting the services Medicaid provides.


Why are nationwide advocacy organizations concerned?
After Congress failed to pass Medicaid caps as part of ACA repeal in 2017, the effort shifted to the states. If approved, Utah would set a dangerous nationwide precedent.


What can we do?
We have made it easy for you! You can speak up against harmful caps by filling out a brief survey that will be linked here:
Your response will be documented as a “public comment”, which is an important formal step in the 1115 waiver process. Since SB 96 is requesting provisions that are usually illegal under Medicaid law, the state must go through a complicated approval process. Part of that process includes collecting, reviewing, and responding to comments from the public.

You can also submit a comment directly either online:

or via email:

There will also be two public hearings, June 6th from 2-4 PM, and June 17th from 4-6 PM.


Do comments actually matter?
Absolutely, yes!!
Public comments have recently been used in litigation against work reporting requirements and have made a real difference in getting those harmful red tape barriers overturned in Arkansas and Kentucky.
Likewise, Utah’s comments will play a role in any upcoming legal challenges.


How can we learn more?