Medicaid recipients will pay for more of their care as Utah tries to contain costs in the rapidly expanding program.
Medicaid - a categorical health-care program for low-income people who are elderly, blind, disabled or on welfare - has been growing annually by 15-25 percent for the past four years. Last year the Legislature asked officials to find a way to control spiraling growth.Beginning Jan. 1, Medicaid clients will pay a co-payment if they use hospital emergency rooms for non-emergencies, said Joan Gallegos, director of the Division of Health Care Financing, which administers Utah's Medicaid program.
"Hopefully it will be a deterrent for inappropriate use," she said. "Many people use the emergency room to get primary care services."
Federal law says the state can levy a $3 co-payment, but officials are asking for a $10 co-payment and the right to levy it against all Medicaid recipients. Currently, there's a ban on collecting from children, pregnant women, people who are institutionalized, HMO enrollees and others. The co-payment would not only help cover program costs, but would force Medicaid recipients to take some responsibility for their decisions regarding health care, she said. In the spring they may add co-payments for pharmacy, physician and dental services.
Other changes that should have substantial impact on cost include an increase in money for primary-care doctors and changes in hospital reimbursement rates so that real emergencies are reimbursed better, Gallegos said.
Utah is also imposing an asset test for pregnant women who apply for government-funded medical care. If the federal government approves it, women who have more than $5,000 in assets would be expected to contribute 4 percent of those assets toward the cost of their care, up to $3,367. That's the average cost of pregnancy care in the state.