New Medicaid rules likely to dump clients, burden taxpayers, group says

Sixty-one years after Medicaid was created to provide safety-net access to healthcare for vulnerable Americans, the program has sustained the biggest cuts in its history. And that has advocates for low-income children and adults, as well as for people with disabilities, warning that lost coverage will not only hurt them but also strain hospitals and care providers, taxpayers and others.

The Protect Medicaid Utah Coalition warned Thursday in a news conference cosponsored with United Today Stronger Tomorrow at Sacred Circle Healthcare in Salt Lake City that the consequences could be worse even than predicted, threatening tens of thousands of Utahns. Speakers said the 300 pages of new rules from the Centers for Medicare and Medicaid Services — with the comment period ending Friday — are much more stringent than those passed by Congress in the One Big Beautiful Bill Act or HR 1.

They’re urging lawmakers to dial it back and protect a program designed to protect the most vulnerable Americans.

Among changes to Medicaid, the bill cuts funding significantly over the course of a decade. But it also changes program requirements, adding specific work requirements, twice-a-year eligibility checks and alterations on provider taxes that some states use to meet the matching funds requirement. Medicaid is primarily funded by the federal government, but states each have to match based on a percentage that varies based on a federal formula.

Since Medicaid was created, the program has “enabled stability and prosperity for hundreds of thousands of Utah families across every corner of our state,” said Rachel Craig of the Association for Utah Community Health. “The creation of Medicaid was a momentous step in our country’s commitment to ensuring affordable healthcare access for all, regardless of where you live or how much money you have.”

She noted that community and rural health clinics provide accessible and low-cost primary care services to the state’s underserved communities, as well as other services. Besides bolstering health, it provides financial stability for patients and the clinics themselves, she said.

Impact of new Medicaid rules

There are several chief complaints about the cuts and the proposed rules, including work requirements and reporting verification that will be difficult and time-consuming and, for some, undoable.

Said Craig, “New requirements will cut tens of thousands of Utahns off from healthcare by forcing harsh work reporting requirements, despite the fact that the vast majority of Utahns on Medicaid either already work — in many cases multiple jobs — or otherwise qualify for exemptions due to disability."

New requirements could make it harder for people on Medicaid to work if their health suffers because of critical cuts. The impact could be strongest in rural areas, where services are already not robust enough to meet the need and people sometimes have to travel long distances to access care, among other challenges.

A physician’s view

Dr. Suzanne Harrison is both a physician and a Salt Lake County Council member. She didn’t mince words about the value that Medicaid provides to those with extremely low incomes or who experience chronic homelessness. She said proposed cuts threaten to wind back the good work the Republican-dominated Utah Legislature had done creating Targeted Adult Medicaid to provide uninterrupted healthcare for those Utahns.

“The program provides a stable foundation, and it has enabled thousands of Utahns to get off the streets and maintain sobriety and reenter the workforce,” she said. “This program works. The new federal cuts in HR 1 and additional cuts by the Centers for Medicare and Medicaid Services will eliminate this program, setting our state’s efforts to end chronic homelessness backwards and shifting costs to local governments and ultimately local taxpayers.”

Harrison warned that Medicaid cuts that “saddle local governments and taxpayers with more costs will make citizens less healthy and streets less safe.”

Speaking for the Disability Law Center, Nate Crippes noted the very recent 36th anniversary of the Americans with Disabilities Act, which was created to help those with disabilities live in a society that fully includes them. He said that those most affected by the cuts are neighbors, friends, family members and those living with disabilities.

“These are people striving to work, contribute to their communities and live independently. We were told repeatedly during the debates around HR 1 that the cuts would not impact disabilities, but the latest interim final rule makes clear that people with disabilities will disproportionately be impacted.”

Added Crippes, “The rule goes much further than the law required and will definitely lead to people losing access to coverage. If we are serious about ensuring that Utahns with disabilities can lead self-directed lives, participate fully in their communities, and enjoy the opportunities promised by the ADA, then we must protect the Medicaid services that make those goals possible.”

The view where rubber and road meet

Lorena Horse, executive officer of Sacred Circle Healthcare, which is owned by the Confederated Tribes of the Goshute Reservation, said Medicaid allows individuals to get preventive care and manage chronic conditions, saving both money and suffering.

“Medicaid is more than just an insurance program,” she said. “It’s an investment in health.”

Horse said that Utah has invested both time and resources to building a Medicaid program that improves healthcare access across both urban and rural communities, allowing people to “remain healthy, employed and engaged in their families and our communities.” Weakening the programs undermines efforts to keep the program and its participants healthy.

“Reductions in Medicaid funding does not eliminate healthcare needs,” she said. Rather, ”it simply shifts costs to emergency rooms, hospitals and taxpayers in other areas."

She also cited the cost of more paperwork, more frequent eligibility reviews and more complicated applications — barriers with “significant negative health and community consequences.”

Ronnie Bateman, who established Bateman Public Health to help domestic violence survivors navigate divorce and child custody cases, has seen firsthand how Medicaid helps put lives back together by allowing them to get care, including mental health services and needed physical help, she said.

“A lack of medical coverage is just one barrier among many that prevents domestic violence victims from leaving their abusers,” she said. She added that she knows people who have not even tried “because the upfront administrative burden was too great.”

What Medicaid recipients say

Two Medicaid recipients addressed their own challenges directly.

Brenda Oluwalana, of West Valley City, can see because Medicaid and “the doctors I would never be able to access without it” provided eye care when she had a series of retina tears and other eye problems. “Medicaid was there” for the follow-up visits and interventions, she said.

“That kind of continuous, unglamorous care is exactly what people don’t see when they picture Medicaid cuts as a line on a budget,” she said. “They don’t see the follow-up appointments that detect the second detachment and prevent future ones” or the “device that keeps the pressure in someone’s eye correctly calibrated for years after.”

Oluwalana agrees with the notion that close to $1 trillion in cuts to Medicaid over the next decade will lead millions nationally to lose coverage, “many simply because of new paperwork, twice-a-year eligibility checks and cumbersome new reporting requirements, not because they don’t qualify for it or they don’t need it.”

Stephanie Foster works as a substitute teacher and said the cuts and proposed paperwork make verifying eligibility especially challenging in her job. Her income fluctuates. And because school is out during the summer, she would not meet requirements unless she got a temporary job, which she has tried to do. The way the paperwork is crafted creates an untrue view of her situation, where she has to apply and reapply and it looks like she’s jumping from job to job, she said.

Harrison said some law enforcement organizations and members of the Salt Lake County Council signed letters asking the Centers for Medicare and Medicaid Services to reverse the decision to end waivers that allow programs such as Utah’s Targeted Adult Medicaid, which has been a lifesaver and life changer for those who are experiencing chronic homelessness to get off the streets and get the care that they need. “Losing targeted adult Medicaid will set our state backwards, and we have asked for a reversal of that decision at the federal level.”