SALT LAKE CITY — A small group of Medicaid expansion advocates showed up Monday as the Utah Department of Health held a public comment hearing on its “fallback” plan, which would expand coverage to those who make up to 138% of the federal poverty level, with some requirements.
Paul Gibbs — who has said Medicaid saved his life when he needed a kidney transplant years before — was one of the few advocates who commented Monday, praising parts of the waiver, like the expansion to 138% of the federal poverty level, and opposing others, like a community engagement requirement.
The community engagement part of the waiver would require enrollees to show they’ve participated in job training and job searches.
“Whether we want to call it community engagement or work requirement, or work effort, whatever we call it, it’s still a bad idea,” Gibbs said.
He said studies have shown similar work requirements not to be effective, and don’t help people get access to health care or employment.
“It just works against the purpose of Medicaid, which is to provide health care for poor people in need,” Gibbs said.
The waiver would also require enrollees to pay some premiums, including a $25 copayment for non-emergent use of the emergency department for those with incomes between 100% and 138% of the federal poverty level.
Gibbs expressed concerns with those premiums, though he said most making average incomes would love to have their premiums that low. But for some, “$20 can be a huge expenditure. It can be a huge hardship. We’re not talking about making people choose between their health care and their iPhones, we’re talking about making people choose between health care and food.”
Jim Rounds, another community member, also urged the health department to remove the work requirement aspect. “First, it costs the state money, because in order to track when recipients of Medicaid are looking for work, then state employees have to be employed, and that costs money to have them review those submissions.”
He said he believes the work requirement would prevent people from accepting higher-paying jobs, because if they make over 138% of the federal poverty level, they’ll be removed from Medicaid.
State Medicaid Director Nate Checketts responded that there are programs in place to help families in such situations, like the Children’s Health Insurance Program.
Jessie Mandle, senior health policy analyst for the group Voices for Utah Children, expressed concerns with the provisions in the fallback plan. She said the requirements are “adding to the administrative complexity of the program” in the form of more paperwork. It can lead families to lose their coverage because they don’t realize they missed extra paperwork, Mandle said.
The fallback plan would also require enrollment in an employer’s plan with premium reimbursement when offered. The program will sunset if the federal fund match falls below 90%.
The health department believes between 120,000 and 140,000 people will be eligible for the benefits. It is seeking approval of the items in its fallback plan from the federal government by Dec. 31 so that it can “implement as many components as possible” by the beginning of next year.
Utah has been in a holding pattern since it received an informal rejection from the federal government on waivers under its limited plan that covers adults up to 100% of the federal poverty level with a self-sufficiency requirement and per-capita cap.
Utah sought a federal 90% funding match from the federal government, but the Centers for Medicare and Medicaid Services said it would deny waivers from states that were allowing fewer people to be enrolled than required by the Affordable Care Act.
According to expansion bill SB96 — passed as an alternative to full expansion called for by voters under Proposition 3 — the state has to work through a couple of options before Medicaid would be fully expanded. If those proposals are not approved by U.S. Centers for Medicare and Medicaid Services by July 1, 2020, the health department must then institute full expansion in Utah, increasing eligibility to those making between 100% and 138% of the federal poverty level under the Affordable Care Act.
The department released the fallback waiver and began accepting comments on it late September and will continue through Oct. 27.
A second public comment meeting will be held from 2 to 4 p.m. Thursday in Room 125 of the Cannon Health Building, 288 N. 1460 West in Salt Lake City.
Comments can also be submitted online at medicaid.utah.gov/1115-waiver or medicaid115waiver@utah.gov.