Utah may not get health-care reform for the poor as quickly as first planned. But the state is not abandoning Medicaid expansion.

In the wake of elections that altered the partisan makeup of Congress, Utah is opting to slow down and take a "wait-and-see" approach, according to Joan Gallegos, director of the Division of Health Care Financing, which administers the state's low-income medical assistance programs.The fear, she said, is that if Utah moves too fast and federal plans change, the state could be stuck with a huge tab for the program. Right now, Utah enjoys a nearly $3 federal per $1 state match rate.

But advocates of health-care reform say the state is sending mixed messages by backing off its blue-print.

"What they're afraid of in state government is exactly what they've been asking for," said Bill Crim of Utah Issues. "Everyone wants local autonomy and the feds off our backs. Now the Republicans are in and say they are going to give people that, and (Utah's) afraid of it. It's like saying don't give us federal mandates; get the feds out of Utah. But then we're not going to do it ourselves, either. It sounds really conflicted."

Utah was anxious to draft its own health-care reform plan before a federal plan was put together, to improve its input into the national process. Gov. Mike Leavitt took a blue-ribbon panel's recommendations, modified them and came up with "Utah Health Print."

Under his reform, Medicaid expanded last July to provide medical care for all children up to age 18 with incomes up to the federal poverty line.

Next July, the state plans to provide Medicaid coverage to all "aged, blind and disabled" people living in poverty. Money for that is included in the governor's budget proposal but must still be approved by the Legislature.

In the third phase, Medicaid would cover all people up to the poverty line, regardless of age or disability. The move, designed to be "cost neutral," would be funded by savings elsewhere in the Medicaid program, Gallegos said.

That's where reform has stalled in Utah, at least temporarily.

Utah will follow its original plan to present phase three expansion to the Legislature in January. With its approval, Gallegos will apply for a federal waiver to extend the coverage. But it won't be implemented until the state has a clearer picture of federal plans - if any - for Medicaid and health-care reform in general.

"We're very committed to health-care reform," Gallegos said. "But we do it incrementally in this state; we don't do anything with a big-bang approach. There are pieces that must fit with the federal climate and the state climate and that's one of the things we need to be very cautious about."

"From the perspective of the people who don't have health insurance, the worst thing they can do is continue to wait," Crim said. "They suffer when as a state and country we can afford to give it to them.

"It's bad economic policy" for people to do without cheap preventive, prenatal and primary care, then have to seek more expensive critical care, he said.

The state is doing several things to save money in order to fund the expansion. Most Medicaid clients are now part of a managed-care system. Costs are also being shifted to recipients, who now pay premiums and make co-payments. And money will also be saved because people who now rely on the state-funded Utah Medical Assistance Program will be covered under the expansion, with federal money bearing most of the cost.

At worst, Gallegos said, the cautious approach to reform will delay the expansion a year.