SALT LAKE CITY — In early 2012, Kat Martinez's infant son had a bad case of a respiratory illness called RSV.
Martinez and her family had no health insurance, so she put off a visit to the doctor in the hopes of remedying her son's illness at home, but the infant's condition worsened.
"I remember sitting in the bathroom with the shower going, trying to get the humidity going ... and thinking, 'I can't afford to take you to the hospital. Like, I don't know if I can pay rent if I take you to the hospital. But can you make it through the night if I don't?'" Martinez recalls.
Martinez's son was ill enough that she felt she couldn't take any chances, so she brought him to an emergency room, where he stayed overnight.
"We eventually got the thousands of dollars of medical bills that would eat at every extra penny for the next few years to pay off," the Murray woman said. "But just to have to make that decision at all is just so overwhelming."
Martinez shared her story Monday with Utah health care advocates, making her case for passing Proposition 3's Medicaid expansion plan next month in order to make roughly 150,000 more Utahns eligible for the federal health insurance program.
At Monday's roundtable forum in Salt Lake City, hosted by Modern Medicaid Alliance, a national health care policy group, patients and advocates shared their views of recent changes to Medicaid in Utah, and what they would like to see from the program in the near future. Public health experts with the Salt Lake County health and human services departments also shared input.
Adam Cohen, CEO of the Odyssey House addiction treatment center, praised the targeted Medicaid expansion that went into effect in Utah late last year, designed to serve 4,000 to 6,000 of the state's very poorest and improve their access to behavioral health services.
For low-income Utahns seeking treatment at Odyssey House, that Medicaid innovation has drastically reduced their wait time as the number of beds available has increased, Cohen said.
Before, a person's wait "would have been anywhere from 8 to 12 months," but now, a person applying can sometimes find an open slot at Odyssey House right away, Cohen said.
In behavioral health, helping a person find treatment as soon as possible after they decide to seek it can make all the difference, Cohen said.
"People’s motivation waxes and wanes, and it mostly wanes, so when you can capture somebody in the moment, and when they say they want to get treatment, you better grab them now," he said.
Odyssey House client Cedric Willis was referred to behavioral health treatment as part of Operation Rio Grande — a multi-agency effort to root out crime and drug use near the homeless shelter in downtown Salt Lake City-.
Willis, who was homeless for about six months, said he personally met others who were waiting up to seven months to get treatment at Odyssey House. But when he was referred, he didn't have that wait, he said, "so I took advantage of that."
Thanks in large part to that treatment, Willis now has his own apartment — "a comfort you just cannot describe" — and a steady job. He plans to transition to an employer-sponsored health plan soon.
Now, he said, "I don't have to worry about having to go in to the hospital without (any) coverage."
Danny Harris, executive director of AARP in Utah, said the success of the targeted expansion shows that Utah has "seen tremendous results within each one of those categories" currently eligible for Medicaid.
"But I’m also sympathetic to the tens of thousands of other Utahns who don’t fit into a category, and because they don’t’ fit in a category in Medicaid, they simply don’t qualify for any of the benefits," Harris said.
Any Utahn who earns income at 138 percent or less of the federal poverty level would be made eligible for Medicaid by Proposition 3, regardless of any other currently required qualifiers — an extension of coverage known as full expansion.
The measure would raise the state sale tax from 4.7 percent to 4.85 percent, which the Proposition 3 campaign, Utah Decides Healthcare, estimates would bring in $91 million and unlock $800 million in matching federal Medicaid funds.
Supporters of Proposition 3 say fully expanding Medicaid is critically important for the health care access of approximately 150,000 Utahns who fall in a "coverage gap" in which they earn too much income to be eligible for the federal program, but too little to qualify for essential cost-saving subsidies on plans sold on the federal health exchange or to afford employer-sponsored coverage.
Martinez says that her family "fell in that gap" for "several years." When her family has avoided that gap, "we were really able to be self-reliant and start building that nest egg," she said. "It's a huge difference."
State lawmakers opposed to full Medicaid expansion have warned it could overwhelm the state budget if federal matching rates decline, and have defeated it multiple times in recent years.
But this year, state legislators passed their most extensive form ever of Medicaid expansion, agreeing to offer eligibility to all Utahns at 100 percent or less of the federal poverty level. It must pass a thorough federal approval process.
Legislators who voted for it have said it would carry significantly fewer concerns about the effect on the state budget compared to Proposition 3, and would make between 70,000 and 90,000 Utahns newly eligible.