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New Medicaid plan helps thousands, but not all

SALT LAKE CITY — After four sessions and even more months during the interim spent talking about and attempting to pass something akin to Medicaid expansion, they finally did it. Utah lawmakers this year agreed to a plan to get more Utahns enrolled in Medicaid.

"It's a great step in the right direction," said RyLee Curtis, senior health policy analyst at the Utah Health Policy Project, an advocacy group for the uninsured. She knows people are grateful for the progress, but sees the latest success as a "foot in the door" for future and further expansion.

After several failed attempts in previous years, Utah lawmakers clearly didn't have the appetite for anything more this year.

Bill Tibbitts, associate director at the Crossroads Urban Center for homeless individuals and families, gives props to Rep. Jim Dunnigan, R-Taylorsville, for coming up with a plan that not only Republicans and Democrats could agree on, but that also won favor of both the House and the Senate.

HB437, Dunnigan has said, is a straight-forward approach that will extend eligibility of the existing Medicaid program to a new population of people — the chronically homeless, convicted criminals and those with substance abuse disorders or mental illness. It may also include some childless adults making up to less than 100 percent of the federal poverty level.

The bill aims to serve about 16,300 Utahns, with a spending cap at about $100 million on services, which includes new tax revenue and federal matching dollars.

Many of the people the new plan will benefit are the same who frequent the food pantry at the Crossroads Urban Center. Tibbitts said he's certain it will make a difference in those lives.

"I don't live in a world where $100 million is nothing," he said. "This is a big deal."

But, Tibbitts pointed out that a large subset of Utahns, including individuals and families, will still be going without access to health care.

"I believe our state will eventually do something to cover everybody in the coverage gap. But, for this year, it was important for legislators to figure out what they could agree on and to do something," he said.

The expansion made possible by HB437 won't be in place until at least July 1, when the new fiscal year begins, and it might also take some time for the state health department to craft a waiver and gain federal approval for the changes it hopes to implement.

The fact that the bill, now awaiting signature from the governor, has a Medicaid expansion fund built into it and the potential to increase the hospital assessment to help cover additional costs, among other things, Curtis said, are promising and likely an indicator that lawmakers could expand the program in the future.

She said that she and many others, including various advocacy groups, are hopeful that what's been agreed upon isn't the final say.

"For the first time in four legislative sessions, our lawmakers are recognizing the moral and economic benefit of helping adults without children," Curtis said, adding that it will result in better lives for many. "I'm fully optimistic that we can come back and build on this program … and gradually become more inclusive."

She said about 43,000 Utahns will be "left out" of the current plan, "still living below poverty without access to comprehensive health care coverage."

"Nothing changes for these individuals," Curtis said. "They will continue to go without, to cycle in and out of the emergency room when it gets bad enough and they will continue to prolong care and ration medicines."

Even those who will continue to go without, she said, recognize that "this is a good step." And, Curtis vows, the Utah Health Policy Project will continue its work to reach out to people who could benefit from the expanded eligibility, but also keep track of Utahns who need more.

The many individuals who have shared their own experiences living without insurance and access to quality health care, Curtis said, will also keep appearing at public meetings and will advocate for themselves and others until full expansion happens in Utah.

Democratic lawmakers at the end of the session said they will forge ahead despite what they called very limited strides made this year.

Sen. Gene Davis, D-Salt Lake City, said he has and will continue to back full expansion until "it becomes accessible for Utahns in the way that the Affordable Care Act intended it to be." He said he plans to engage in discussion in the coming months to see what can be done to further increase access, since his bill for full expansion failed to gain enough support to pass during this session and the last.

One of the intents of expanding Medicaid to just a small percentage of people who need it, Dunnigan said, is to see how it works and to gather real data on how much it will cost the state. From there, he said, state leaders can better anticipate future changes to the program, if there are any.

"They did reach a compromise. If you can call it that," said Stacy Stanford, a 30-year-old student and small-business owner who is uninsured and remains undiagnosed on severe health issues resulting from a car accident several years ago. "The people that will be covered, there is a definite need. But, there's still 40,000-some odd people being left out of the equation who have just as much a need for health care."

Stanford of Salt Lake City, is concerned that the people absent from the newly approved plan are largely the working poor, like her, who are "doing what we can" to make ends meet, but still don't have access to health insurance nor the means to pay for it.

"The message coming from the legislature seems to be that unless you're one of the most destitute, not a penny to your name, living on the streets, have substance abuse or mental health disorders, unless you're really at rock-bottom, then you better be able to grab your boot straps and hold yourself up," she said.

Like many others who have been in the fight for access to quality health care since it began in Utah, Stanford is committed to keep pushing for it.

"I will continue this fight until every person in the coverage gap has access to health care," she said.

The process, Stanford added, has, however, served as a "wake-up-call" more than anything. The sign she made for one of the first rallies in support of Medicaid expansion that she attended years ago, reads "Not Dead Yet" and it still hangs in her living room, as a reminder that more can be done, that her plea isn't over.

"I won't take it down," she said.

Since the bill passed this year, Tibbitts said he hasn't stopped thinking about all the people it will help and "all the people who would've benefitted from something like this if it would've passed sooner," he said.

He's anxious to see people changed for the better by the new expansion of benefits.

"This was crafted in a way that it should help anyone who needs it," Tibbitts said. "If they can get the health care they need and go back to work, that will be awesome."

Email: wleonard@deseretnews.com

Twitter: wendyleonards