John Morgan had big plans for the $12 monthly cost of living increase he was expecting to get in January as part of his Social Security check. Instead, the state of Utah will be collecting the money from Morgan and other frail, low-income Utahns who must buy their way into the Medicaid program.

It's the only health-care program he has.Morgan can't work. His epilepsy became so severe that his doctor pulled the plug on employment.

To live, he receives a Social Security check for people with disabilities (SSDI). At age 42, Morgan isn't eligible for Medicare. Instead, he gets medical assistance through the state.

He takes part in the state "spend down." That means that he pays the state the difference between his income and the eligibility requirements. There are some deductible expenses, but generally, the income limits are $361 for a one-person household, $443 for two and $553 for three people.

He's frustrated because he won't see any benefit from the tiny cost-of-living adjustment (2.6 percent this year, second-lowest in history) granted to people who rely on Social Security.

"I talked to state officials about it and how bad I need the money," Morgan said. "The response I got was `tough bananas.' Costs are going up. My rent goes up, utilities go up, the cost of doing laundry goes up. But we don't get an increase, the state does.

"The federal government is getting lots of publicity: `Yeah, we're Mr. Good Guy because we're giving them increases.' But a lot of us are really hurting and the state gets to keep that little bit of money that would help."

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Rod Betit, Health Department director, sympathizes with Morgan's complaint. It's true, he said, that these people who have such very low incomes don't get the small annual adjustments. But that's a federal rule.

"If someone is getting Supplemental Security Income and Social Security, he's automatically eligible for Medicaid without the spenddown," Betit said. "SSDI is considered Social Security and there's no automatic eligibility."

That $12 increase could have been even more costly for Morgan. Originally, public assistance officials were going to lower his food stamp allocation $5 because of it. And even a very small COLA can jeopardize Medicaid eligibility.

"That's why we have what's called a pickle provision. If you'd be eligible and the COLA puts you over the top, we continue to cover you and we get the COLA," Betit said.

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