Medicaid Expansion Hearings End With Lackluster Public Input | KUER 90.1

Medicaid Expansion Hearings End With Lackluster Public Input

Jun 17, 2019

Utah’s Medicaid expansion plan had a final public hearing Monday night in Salt Lake City. After the window closes for online comments at the end of the month, officials with the health department will then submit the proposed changes to the federal government for approval as a waiver.

The waiver would allow major changes in the program, including the option to cap the number of people who could get access to the low-income health program, a funding cap on how much money Utah would get from the federal government, and a controversial work requirement, among a dozen other changes.

Still, public comments have been sparse. About 15 people commented at Monday night’s meeting. That’s up from just 10 comments during an earlier hearing in June. According to Medicaid Director Nate Checketts, no public comments have been posted online so far. Checketts attributes the light response to confusion about the state of Utah’s Medicaid program and who is eligible.

“I think people have heard the message that Proposition 3 passed and it was replaced by S.B. 96, and people are talking about not liking that. I don’t know if they realize that on April 1 we expanded to 100% [of the federal poverty level] and people should apply,” he said.

According to Checketts around 30,000 newly eligible individuals have enrolled in Medicaid in the first three months of the expansion program, significantly fewer than the 50,000 they projected would sign up by now.

Health care advocates pushing for full Medicaid expansion to 138% of the federal poverty level made up a sizable proportion of Monday’s meeting.

“We’re trying to notify our advocates and the people who supported Prop. 3 that the work is not done,” said Courtney Bullard with the Utah Health Policy Project. “We know you’re jaded, but this is a population that needs health care and we’re going to keep working until they get it.”

Both Bullard and Checketts said they expect an increase in public comments by the end of the month when the comment window closes.

Monday’s public hearing came as a community advisory group for Utah’s Medicaid program is voicing opposition to proposed changes in the waiver.

Members of the Utah Medical Care Advisory Committee are submitting a letter opposing changes by the legislature to Proposition 3, the citizen ballot initiative to expand Medicaid.

A copy of the draft letter was read to KUER by Dr. Bill Cosgrove, a pediatrician and the chair of the committee.

As an advisory committee we believe that many of the components and programs proposed in this waiver application undermine the objectives of the Medicaid program and the stated goals of the waiver. These are unprecedented changes with the potential for serious consequences in Utah and nationally.

In particular, the advisory committee opposes:

  1. A partial expansion which has resulted in fewer individuals able to access affordable Medicaid coverage and left many uninsured.
  1. The per capita cap funding mechanism which has the potential to put the financial stability of the Medicaid program at risk by reducing available federal dollars.
  1. Caps on participant enrollment which could deny many the coverage they need.
  1. The community engagement requirement which has the potential to add administrative complexities and barriers to Medicaid participants.
  1. Waiving EPSDT [Early and Periodic Screening, Diagnostic and Treatment] benefits for 19 and 20-year-olds which will leave many young adults without cost-effective prevention screening and early detection assistance.

As the appointed state Medicaid advisory committee, we wish for our opposition to these programs and components to be included as part of state and federal comment record. These proposed changes create holes in our public health safety net. They will make it more complex and difficult for Utah Medicaid participants to access the care they need to improve their circumstances and become self-sufficient.

We urge state and federal officials to not move forward with these programs and components.

“We are simply trying to say ‘We as a group who invest a lot of time and energy in overseeing Medicaid have looked at this and find that it comes up short in many ways,’” Cosgrove said.

The Medical Care Advisory Committee is made up of a variety of groups long opposed to the legislature’s Medicaid replacement plan including Utah Health Policy Project, Voices for Utah Children, AARP Utah and the Disability Law Center.

Members of the advisory committee who are employed by the state would likely not comment on the letter, Cosgrove said.

Proposition 3 would have extended coverage to an estimated 150,000 low-income Utahns residents. The legislature’s current Medicaid expansion plan extends coverage to an estimated 70-90,000. The remaining individuals would get access to deeply subsidized health insurance on the Affordable Care Act marketplace.

Neither Rep. Jim Dunnigan (R-Taylorsville) nor Sen. Allen Christensen (R-North Ogden), the sponsors of the legislature’s Medicaid expansion bill, were available for comment. An official from the Centers for Medicare and Medicaid Services declined to comment on the proposed Medicaid changes, citing that they have not yet been evaluated by the federal health department.

Monday night’s hearing was the final opportunity for members of the public to comment in-person. Online comments about the proposed changes can be submitted until the end of June.