Utah's Republican governor announced Thursday he wants to reject a full Medicaid expansion, and instead, seek federal dollars to cover the poor.
Gov. Gary Herbert's decision came after months of pushing back an announcement, making him one of the last governors in the country to announce his intentions about expanding Medicaid.
Herbert, like many Republican governors, is opposed to President Barack Obama's signature health law but has said the state has an obligation to help the poor.
About 60,000 Utah residents are not currently covered by Medicaid or eligible for federal subsidies to pay for private insurance.
Herbert has said that while Utah did not create the problem, it's not right or fair and something must be done to help.
His plan would use the money Utah would have received to fully expand to help those up to 133 percent of the federal poverty level. The money would help them purchase private plans.
It would cover those 60,000 falling through the gap, and then some, helping about 111,000 people.
The block-grant path is relatively rare but shares similarities with plans in other states, such as Arkansas and Iowa, which have received federal approval.
Utah, too, would have to receive such a waiver from the federal government.
Under the federal health care law, states have the option of expanding eligibility for Medicaid, the state-federal program for low-income people.
If states expand the program to include people making up to 138 percent of the federal poverty level, the federal government has offered to pick up the full cost through 2016 and 90 percent after that.
Like other Republican governors, Herbert has resisted embracing full expansion, citing fears that the federal government may fail to keep its part of the agreement down the road.
Overall, 25 states and Washington, D.C., are expanding their Medicaid programs, while 19 others have opted not to expand. Decisions are pending in other states.
Beyond federal approval, Herbert also needs to secure the support of Utah's Republican-controlled Legislature, which has less than two weeks left in its 2014 session.
In states like Arkansas and Arizona, plans to expand Medicaid have been hung up as Republican governors wrestled to get GOP-controlled Legislatures to agree to fund the plans.
In Utah, the governor has said he wants to bring the Legislature on board with a decision.
His administration has been holding closed-door talks with lawmakers to find middle ground on the issue.
Herbert's toughest battle is expected to be with fellow Republicans in the House, including House Speaker Becky Lockhart, who is widely considered to be weighing a bid to challenge Herbert for the governor's office in 2016.
Lockhart and Republicans in her chamber announced their own Medicaid plan last week. It rejects more than $500 million from the federal government, instead spending $30 million to $35 million in state money to cover the neediest of people living below the poverty line.
It's unclear how many of the 60,000 would be covered under the two-year plan, which prioritizes parents and the medically frail.
Lockhart has said that legislators could then take advantage of more flexibility available under the health law in 2017.
Herbert has called the plan illogical, arguing that Utah residents send their tax dollars to Washington, D.C., so they deserve to have them spend back in their state.
In the Senate, Republicans have discussed several options but have not coalesced around a single plan.
Democrats, who are in the minority at Utah's Capitol, have pushed for full expansion, saying it makes the most sense morally and financially.
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