Proposed Medicaid Changes: What’s at Stake?

The Utah Department of Health is proposing unprecedented changes to Utah’s Medicaid program that will cause many to lose coverage and have a harder time accessing care.  These changes include:

  • Time limits on enrollment for PCN and adults without children. These populations will be limited to 60 months, even if they have a chronic condition or disability, even if they are working or caring for a child
  • Work requirements for PCN enrollees. Failure to complete will mean an enrollee loses coverage
  • Penalties for non-emergency use of the ER, and no additional case management or patient education to help enrollees

The Department wants to move forward regardless of what happens to Medicaid in Congress’ health care bill. Learn more about the substance of these proposals, or visit the Department of Health’s application here.

Take Action!

  • Submit comments online by July 20th here.
  • For sample comments, check out this comment template here.
  • Share your comments and voice your concerns at the Public Hearing on July 10th between 3pm-5pm at the Cannon Health Department: 288 North 1460 West, Salt Lake City, Room 125. Call-in Line: 1-877- 820-7831, passcode 313537#
  • Please let us know if you submit comments so we can ensure media know how many people spoke out.
  • Call or email your state legislators to urge them to speak out against the Department of Health’s proposals, and demand more time to understand the impact of these proposed changes on Utahns’ care.

Every comment matters. Tell the Department of Health to protect care and coverage. These proposals will hurt, not help Utahns.

waiver changes

Utah Medicaid Basics

Utah Medicaid and the Primary Care Network (PCN) are health care programs for low  income Utah residents. There are over 300,000 Utahns enrolled in Utah Medicaid. Below is a summary of some of different populations covered by Medicaid the different programs which will be affected by this waiver:

Adults without Children: In 2016, the Utah Legislature passed H.B. 437 that will extend Medicaid coverage to a limited population of adults without children below 5% of the federal poverty level. To qualify individuals must be chronically homeless, involved in the justice system and in need of substance use or mental health treatment. Otherwise, adults without children are not eligible for Medicaid, and can instead apply to the Primary Care Network. These changes have not yet gone into effect. To learn more visit the Department of Health’s information on adult expansion.

Parents or caretakers: Parents or caretakers may be eligible for Medicaid if they are below 60% of the federal poverty level. Otherwise, they are not eligible for Medicaid, and can instead apply to the Primary Care Network.

Primary Care Network (PCN): This is a health care program, administered through Medicaid, that provides very limited health coverage. Individuals and parents are able to receive primary and preventive care, and limited medications or drug prescriptions. They cannot get advanced treatment, surgery or other care.

Children: Children through age 18 can receive comprehensive Medicaid benefits, if they are under 138% of the federal poverty level. Utah has one of the highest rates of children who are eligible for Medicaid, but not enrolled. One of the driving factors for these low rates is that many parents are not eligible for Medicaid. When parents have health insurance, their children are more likely to be enrolled as well.

Disability Medicaid or ‘Aged, Blind or Disabled’ Medicaid: Individuals may be eligible if they are aged 65 years or older, blind or disabled. Persons who receive SSI (Supplemental Security Income) or Social Security Disability benefits meet the conditions for disability. If the individual is not on SSI or SSA disability benefits, the State Medicaid Medical Review Board may make a disability decision.

Learn more about Medicaid eligibility here.

Waiver Comments Template

The Utah Department of Health is proposing significant changes to Utah’s Medicaid program. Every comment will make a difference. See below for a sample comment template. Comments are due to the Department of Health by July 20th. You can submit comments here. Or come share your comments at the public hearing on July 10th.

Waiver Comment Template:

Dear Medicaid Director Checketts,
The changes to Medicaid sought by the administration would significantly increase the number of uninsured Utahns, keep many in a cycle of poverty, and make our state less healthy.

I object to these proposed changes because they will undermine the health of Utahns including the chronically homeless, people in need of substance use or mental health treatment, people with chronic conditions, low-income parents. Time limits on people’s coverage will be particularly harmful to those with chronic or disabling conditions, people working in a low-wage job, or parents or caretakers.

I support the goal of encouraging people to be self-sufficient and return work. But there are more effective ways to accomplish these goals, without undermining Utahns’ health, including increased case management and patient education. Greater time should be given to studying the impact of these proposed changes on Utahns’ everyday care, before moving forward within increased restrictions. More importantly, with thousands of Utahns still without health coverage, the Governor and Department of Health should first ensure all Utahns can access comprehensive, affordable care, before increasing penalties and limits on their care.

Thank you.


Sample talking points for different populations:

Chronically homeless, substance use and mental health treatment: The proposed caps on enrollment for adults without children will hurt this transient population. If people in this category lose their coverage, they will likely be unable to re-enroll. This will create disruptive gaps in their coverage and care. Consequently, these highly vulnerable enrollees will find it extremely difficult to maintain access to critical treatment and recovery services.

Domestic violence and trauma: If parents or individuals lose their coverage due to time limits or work requirements, it creates an added financial and emotional strain on these already vulnerable families or individuals. Moreover, individuals will experience disruptions in care and may be unable to stabilize a mental or physical health condition, which could put them at an even greater risk for domestic violence, ACES and trauma.

Parents and children: If parents lose their coverage due to time limits or incomplete work requirements, we will see an impact on children as well. When parents have health insurance coverage, children are more likely to have coverage. The converse is also true; when parents do not have coverage, there are lower rates of insured children.

Chronic physical or behavioral health conditions (e.g. depression, diabetes or asthma): Many people on the PCN program rely on the care it affords to manage chronic conditions, but do not qualify for disability Medicaid. As a result, time limits on PCN may be particularly harmful to this group, who may be otherwise unable to continue working.

Working individuals and families: The vast majority of Medicaid enrollees live in households where at least one member is working. Also, nationally over half of non-elderly, non-disabled Medicaid enrollees are already working themselves. While the majority work full-time, most have low-wage jobs that don’t offer affordable coverage options. At the same time, for any number of reasons, almost 1 in 5 are only working part time. An additional 30-hour-a-week job search/work requirement will be especially challenging for these individuals and hit families with older children particularly hard.

Low-income individuals and families using the ER: The federal poverty level is just over $12,000 this year. In order to qualify for the waiver, a non-elderly, childless adult must have a mental health need and/or asubstance use disorder, and earn less than about $600 a year. A non-elderly, non-disabled parent can earn just over $7,200 a year and qualify. In the best case scenario, after estimating housing and food costs, that means a Medicaid expansion enrollee could have between $0-385 a month left for other expenses. With numbers like these, it’s no stretch to image a $25 co-pay for an incorrect use of the ER leading to delayed, and ultimately more costly, care. This is an especially shortsighted suggestion when the state has yet to adequately invest in preventive and non-ER alternatives to off-hours care.