Hundreds of Utah's aged and disabled citizens who need extensive regular medical services are caught in an unusual Catch-22: be a working member of society or qualify for Medicaid benefits.
A provision in the state's regulations says that if a person makes even $1 more than the state's income level cutoff — a figure that varies depending on a number of factors — he will lose all Medicaid benefits unless he "spends down" to that poverty level.
Through a complex, multi-step equation using the $696 federal poverty level, state officials decide whether people qualify for the benefits. If they make too much, they have the option of paying the difference — which can be a substantial amount — to the state or quitting their jobs to fully qualify.
Citizens urged the Medical Care Advisory Committee Thursday to support a work incentive program that would eliminate the spend-down requirement and allow disabled citizens to have jobs. The committee gives advice to the Department of Health and Gov. Mike Leavitt about Medicaid funding and program directions.
Gene Hoefling, program manager for the Department of Health's Bureau of Eligibility Services, said the program follows a 1995 non-mandatory federal provision and will help more than 300 of Utah's disabled citizens.
Quadriplegic Ted Anderson makes $1,600 in monthly earned income but is forced to pay nearly $1,400 to the state to maintain his Medicaid benefits. Because of his pre-existing condition, Anderson does not qualify for private insurance through his employer.
Hoefling said Anderson's situation is not unusual.
"Many people will lose more money in spend-down than they gain in earnings," Hoefling said.
The end result, Hoefling said, is that many people have to choose between working or their much-needed medical benefits.
Tina Johnson, a member of the legislative coalition for people with disabilities, who suffers from a rare form of multiple sclerosis, said the ability for disabled citizens to work is more than a matter of making money.
"Most important to us is that it helps our self-esteem if we can be productive," Johnson told committee members.
Committee member Edward Loosli Jr. asked his fellow committee members to seriously consider backing the program. "It should do for employment what the Americans With Disabilities Act did for access."
Only five states so far have adopted similar work incentive programs, Hoefling said. But more and more are looking into following the federal provision. "This is one of those rules that doesn't make a lot of sense."
The Medical Care Advisory Committee will have one more public hearing before making its recommendations to the state. That meeting is Aug. 17, at 1:30 p.m. at 288 N. 1460 West, Room 125.