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The Utah Department of Health is trying to figure out which types of medical care are most important for low-income people who rely on Medicaid or the Utah Medical Assistance Program.

Thursday, they will hold a public hearing on the issue in the Salt Palace Birch Room from 4 to 7 p.m.It's an issue of broad concern to everyone. People for whom the programs are the only link to health care are obviously concerned.

And since Medicaid is one of the largest budget items in the state, taxpayers must be concerned that the program is as effective and efficient as possible. The state contribution to Medicaid is huge; when the federal matching funds are added in, it becomes an issue of paramount importance.

The Medical Care Advisory Committee, a panel that makes recommendations to the department and to the Legislature, will oversee the hearing.

Too often, the people most concerned about the medical programs - those who use them and those who fund them - have strong feelings that they don't express until the matter is all but decided.

By speaking out now, the public can see that sound decisions are made well in advance of the legislative session, which starts in January.

The state has a preliminary list of priorities. The first six are not negotiable: They must be funded in order to comply with federal mandates.

Those include inflation costs for Medicaid services, utilization and caseload costs (since Medicaid is an entitlement program based on categorical eligibility) and expansion of the program that uses Medicaid funds to pay for Medicare premiums so the federal program picks up primary medical costs.

The state must also "rebase" the payments made to intermediate-care facilities that treat people who have mental retardation.

Medicaid coverage is going to be mandatory for people who live below the federal poverty guideline and are blind, disabled or elderly.

And the state must come up with money to make up a shortfall created when the federal matching rate decreased.

Seven other items are on the priority list, beginning with coverage of physical and occupational therapy and an expansion of transplant services. The final Medicaid item on the preliminary priority list is medical transportation.

For the Utah Medical Assistance Program, building block suggestions include inflation costs, caseload service costs and coverage of psychiatric drugs.

That leaves a lot of gaps for people who have specific needs, which is why anyone attending the hearing will be asked to list their own priorities. Health officials have suggestions, based on the needs they've seen. But people can write in their own, too.

One of the most basic needs on the list is an increase in payment for dental services. Dental work has been an up and down proposition for years. At times, dental care has been restricted to pulling teeth. Now the service is somewhat expanded, but many dentists won't care for Medicaid patients because of low reimbursement rates. That is also true of doctors; officials would like to reward physicians who care for a lot of Medicaid patients by giving them a slightly increased payment.

Tuberculosis treatment is a major concern to homeless folks and those who serve them. Nationwide, TB has been increasing, particularly among the homeless and frail, elderly people in nursing homes.

People who are disabled have been lobbying for specialized wheelchairs, which are prohibitively expensive for low-income people.

Other suggestions include new transplants, bone-marrow transplants, interpretive services (to aid in communication with health-care providers) and home health infusion therapy.

One thing is clear. There will never be enough money in the budget set aside for Medicaid to fund all the needs.

Something will be left out - and that means someone will have to do without badly needed care.

The Health Department wants help making that decision.