A bill making its way quickly through the Utah legislature could create the largest Medicaid expansion in the state in years. That’s the state and federal low-income health insurance program. But, it comes with a catch.
H.B. 472 is one of several Medicaid-related proposals introduced this session, but this one would likely have the biggest impact on Utahns. It would request a Medicaid waiver from the federal government to expand coverage to approximately 60,000 residents. The waiver would raise the income level for adults who qualify from 10 percent to 95 percent of the federal poverty level.
That group is considered to be in the Medicaid gap – people who make too much money to qualify for Medicaid but not enough to be able to buy plans on the Obamacare exchange. Unlike past proposals to expand Medicaid, this one includes work requirements for able-bodied adults.
Work requirements could be something other than having a job, said the bill’s sponsor, Rep. Robert Spendlove, R-Salt Lake City.
"We can really be using this as a way to give people – if they need training, let’s give them training, if they need help with interviews, we can help them with that, if they just need to know how to get into work for the first time – those are all things that we can and should be helping them with," Spendlove said.
Other work requirement alternatives include searching for employment and volunteer activities. The goal is that those skills will help transition people off the state-sponsored health program.
Tying work requirements to Medicaid is new. It’s a policy shift the Trump administration recently allowed states to require. During the Obama years, if states wanted to expand Medicaid they had to go up to 133 percent of the federal poverty level. It was all or nothing. Utah legislators said that would cost the state too much. Now states can expand Medicaid to fewer people in the gap. In fiscally conservative Utah, that earned the support of Governor Herbert.
"The people who are in the gap, we’ll take care of them. We’re gonna help people get off of government assistance and have a better life. It’s win win win all the way around. So I hope this legislation passes," Herbert said.
The idea of work requirements is not universally liked. Stacy Stanford with Utah Health Policy Project said it has the wrong goals.
"By requiring work before providing health care you’re kind of putting the cart before the horse where, if you give somebody good health, then you enable them to find good employment," Stanford said.
She also said by expanding Medicaid to fewer people than the Obama administration required, this proposal will still leave people out who can’t afford insurance.
Spendlove's bill passed 47 to 27 in the House of Representatives on Monday night. It now moves to the state Senate.