More than 7,600 Utahns who have no medical insurance and who do not qualify for any other program like Medicaid have been helped by Utah's Medically Needy program.
The eligibility requirements are stringent, but individuals have been allowed to "spend down" to that level by giving the state the difference between their income and eligibility levels.The federal government doesn't require states to provide the Medicaid-related program. Utah lawmakers chose to provide it.
But under federal regulations Utah's Division of Health Care Financing is supposed to allow people to use incurred bills as part of the spend-down. The division has applied for a federal waiver but hasn't received it yet. State officials claim that the Utah system is equitable and efficient.
Utah Legal Services filed a suit to force the state to comply with federal regulations. The judge agreed.
The class-action suit claimed that the Utah system deprives people who would qualify under the federal system of participating in the program, but there has been a lot of debate over how many people are actually affected.
At least one person has been identified, but health and social service officials say the number is minuscule - certainly not enough to justify the $1 million price tag attached to changing the system.
The issue has even divided low-income advocate groups.
And now, it appears that the lawsuit may jeopardize the entire program and take the very limited medical services away from the people who already qualify.
Money is only part of the problem - although it's a big part. Some legislators have hinted they don't appreciate the lawsuit and will not be forced to change the system.
Instead, they may just cancel the program completely. After all, it is an optional program and with so many programs needing money, the money being funneled into Medically Needy certainly won't be wasted.
On top of everything else, a set of recently released federal mandates has applied even more pressure.
The governor's budget recommendations were released in December. Lawmakers may or may not choose to follow that proposal when they appropriate money during the session. But it will certainly serve as a guideline.
Unfortunately, two federal mandates have come down since the proposed budget was released. And funding those mandates will cost about $3.5 million that isn't in the budget yet.
That means lawmakers either have to expand the budget by that amount or they have to take the money out of other programs.
One thing is definite: The mandates will be funded.
Currently, pregnant women who are at poverty level or below receive Medicaid coverage. Starting in April, another thousand women will be covered because the income level will increase to 133 percent of poverty. Congress ordered that all children under age 6 (right now, it's age 1) in families with incomes up to 133 percent (it's currently 100 percent) of poverty will be covered.
The advocates would normally be very pleased about the mandates, because a significant number of needy people will receive help.
But the timing is abysmal.
Suzanne Dandoy, director of the Health Department, put into words what advocates fear: "As for the Medically Needy program, if you were lawmakers and had mandates you had to fund, and a program over which you're being sued that is an optional program, would you put $1 million into it?"
It seems to be a case of everyone trying to do what he thinks is right. There's no doubt that Utah Legal Services has pursued (and is determined to keep on with) the lawsuit because the staff believes it is in the best interest of the low-income Utahns it is dedicated to representing.
It's equally obvious that Health Department officials recognize the desperate needs of the people who participate in Medically Needy and want to serve them.
The other advocacy groups like Utah Issues and Community Action Program have also fought to protect low-income people by lobbying for funding and programs to benefit them. Nobody wants to lose Medically Needy.
What's going to happen? Only the lawmakers can decide. Their decision will be made, I hope, without regard to any feelings of pique because someone sued the state over the program.
Instead, I hope they will consider the value of the program itself. It offers the last hope for people in desperate medical and financial crises. Thousands of them.
It's a humane program that deserves to be saved.