Health

This Legislative Session, we have heard a lot of thoughtful, important discussion around children’s access to health coverage and care, including needed mental health care. Health insurance helps children connect with affordable care, yet thousands of Utah children are not enrolling in coverage. Utah has the highest rate of kids currently eligible for health insurance, but not enrolled.

Following the Session, Voices for Utah Children will be releasing an in-depth “State of Children’s Care” report that reviews kids’ coverage and care across the state. Here’s a preview look at some reasons why Utah kids are still uninsured…

  • Uninsured Parents= kids more likely to be uninsured: Thousands of parents have been left without have health insurance for too long. On April 1st, parents with incomes between 60-100% of the federal poverty level will be able to enroll in Medicaid coverage. After the passage of Proposition 3 and then Senate Bill 96, there is a lot of confusion among parents around what affordable health care options are still available and the new requirements to getting care. It’s important that up-to-date information is provided to families, so that eligible parents can begin enrolling on April 1st. Research shows that covering parents helps kids.  
  • Keeping kids covered after they enroll: Once kids get enrolled, we need to help them stay covered. Kids can lose coverage because of administrative error, a small change in parents’ income or an employer’s failure to return requested information on behalf of the parent.
  • Misinformation and lack of outreach: Many families are confused about what types of affordable options are available to them. Unfortunately, statewide there is a significant lack of outreach funding to help families learn about options and dispel confusion.
  • Fear: The federal administration has contributed to a climate of fear that is causing many immigrant families to not enroll, or dis-enroll, their children from Medicaid or CHIP, for fear of reprisal. The majority of children with immigrant parents are eligible for coverage but are not enrolling. We need to counter this climate of fear, create a welcoming environment for new Americans and fight the misinformation of using public benefits.
  • Coverage disparities: Utah has one of the highest rates of uninsured Latino/Hispanic children. Alongside fighting the climate of fear for immigrant families, we must also continue to outreach to communities and support families who may not enroll alone.

Unfortunately, as we reported last year, the rate of uninsured Utah children is trending in the wrong direction. For the first time in almost ten years, we saw a troubling rise in the number of uninsured children in our state. Voices for Utah Children is currently working to increase coverage and care for all children with our 100% Kids Coverage Campaign. Let’s work together to help all Utah kids get the coverage and care they need to be healthy and thrive.

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Recently Senate Bill 96 was signed into law by Governor Herbert. Here’s our recap of what’s in SB 96 and the next steps for Utah kids and families’ coverage

Where do we go from here?

The Governor and Legislature have said they are committed to an enrollment date on April 1st, which was also included in Proposition 3. Individuals and parents up to 100% federal poverty level (FPL) will have an important opportunity to enroll beginning on April 1st. We will work to make sure those newly eligible know that they can get coverage. Thousands of Utahns are counting on getting the care they need as soon as possible.

But as we work toward enrolling those newly eligible now, we will not rest until all Utahns get coverage and care without barriers, red-tape, without risk of losing coverage or benefits.

To that end, we will be opposing Utah’s SB 96 waiver applications to the federal government. It is now up to the federal government to approve Utah’s proposed harmful work reporting requirements, caps and coverage restrictions included in SB 96, which will be imposed on newly eligibile individuals and parents.

It is critical that we make sure the federal government hears Utah’s opposition to these harmful waivers. Utahns voted for full Medicaid expansion without caps or lock-outs, added requirements or red-tape. (For more detail on what’s in SB 96, keep reading!)

A Closer Look at How SB 96 Differs from Proposition 3

“Partial expansion” instead of full expansion:

SB 96 rolls back voter-approved full Medicaid expansion. Instead of expanding Medicaid coverage to those up to 138% of the FPL, SB 96 only expands to those up to 100% FPL. Currently, no state has been allowed to do a so-called partial expansion. If approved, partial expansions have serious consequences for individuals and states, as this Kaiser Family Foundation brief explains.  

Enrollment caps and work reporting requirements:

SB 96 imposes added barriers, caps and requirements on Medicaid coverage, if approved by the federal government. Newly eligible parents and individuals will be subject to work reporting requirements. In states that have passed work reporting requirements already, there is no evidence that they’ve done anything to incentivize work. On the contrary, studies from states that have implemented a clean expansion saw that Medicaid coverage made it easier for people to find work, maintain a job and increase their earning potential. SB 96 also includes an enrollment cap and potential lock-out periods for certain individuals, which could leave some with long periods of uninsurance.

Higher costs and higher risks:

SB 96 will immediately cost more than Proposition 3, gambling on federal approval for waivers that will increase Utah’s future financial risks. SB 96 proposes to use a funding mechanism called a Medicaid per capita cap. A per capita cap changes Medicaid financing from being a shared state-federal partnership, to a fixed amount. If states spend more than their capped amount, it could lead to potential benefit reductions or narrowed eligibility requirements. If Utah is allowed to move forward with per capita caps, this could lead to cuts in benefits or fewer people covered in the future.

Waiver requests and federal approval= an opportunity for advocacy and opposing harmful barriers to coverage:

In order to put SB 96’s caps and restrictions into place, Utah must submit waiver proposals to the federal government for approval. We will work to oppose the waivers and prevent federal approval. If the federal government does not approve Utah’s different waiver requests, then full Medicaid expansion should go into effect in July 2020, as stipulated in SB 96.

Also included in SB 96’s waiver proposals are measures that could help adults experiencing homelessness access housing and continuous care. While we believe the broader provisions of SB 96 are harmful, we applaud the Legislature and Governor for these efforts to leverage Medicaid funding in innovative ways.

We hope that going forward we can continue to work toward effective solutions to help vulnerable Utahns get care, without adding barriers, cuts or restrictions to coverage.

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Q: Is there enough money for Utah to expand Medicaid? I keep hearing that the ballot initiative didn’t provide enough money to cover all the costs. Isn’t that why voters chose to increase the sales tax?

A: All fiscal estimates show that Utah has enough money to implement expansion for the first few years, if not longer. A lot of the fiscal impact statements beyond the first years include predictions, different interpretations, and what-if scenarios about the new law.

Bottom line: Utah has the money to implement expansion now;  it’s already in the process of doing so and we shouldn’t slow down.  The sales tax increase that Utah voters supported will ensure there is enough money in the state budget for Utahns to enroll in Medicaid. State agencies are working diligently to implement the law on April 1, as Utah voters approved it. Utah families cannot afford to derail those efforts with costly and burdensome proposals that do nothing more than take our eye off the ball and delay meeting the needs of those who have no other way to afford health care coverage. 

Q: But, really? I hear that other states end up spending a lot more than they expected on Medicaid.

A: There have been numerous, peer-reviewed studies looking at the experiences of other states that have expanded Medicaid, including this Brookings Institute report: Do states regret expanding Medicaid? [The short answer is no]

Medicaid expansion is an economic win for states because of the federal dollars that will be returned. But also because of the many budget offsets that come with Medicaid expansion. States that have expanded Medicaid have consistently found that expansion is a net saver. However, Utah’s current fiscal estimates for Proposition 3 do not appear to include all of the anticipated cost savings and offsets we’ve seen in other states.

Bottom line: The national evidence and data show that the cost to expand for states is minimal, while the overall economic and public health gains are high. Any effort to change Utah’s plan is just a delay tactic that will cost more money and more time and prevent people from getting the health care they need and deserve.  Utah must keep moving forward now. 

Q: So, could the Legislature pass a different Medicaid expansion plan, through a waiver? What does this mean?

A: The proposals legislators are considering would require additional federal approval, through a federal waiver. (Proposition 3 does not require a waiver.) In theory, these plans could cover everyone in the coverage gap. The hitch is that the federal government has to approve such a plan, and there is no public indication or evidence that they would do so, or that any such plans would be fiscally prudent for Utah to implement. What’s more, the Legislature’s plan would require public comment periods, and will be subject to legal challenges, further delaying Utahn’s coverage, not to mention increasing its costs.

In addition, many of the Legislature’s proposed changes to Proposition 3 would include other provisions that put up additional barriers to health care enrollment and amount to radical restructuring of the Medicaid program here in Utah and nationally. These changes make it harder for Utahns to get care and are likely to be challenged in courts, piling on more unnecessary costs and delays.

Bottom line: If the Legislature passes a different Medicaid expansion plan, it will mean more barriers to coverage, increased  administrative costs, and lengthy- if not indefinite- delays. Utah already has a smart, fiscally sound, plan to give families across the state access to the health coverage they need. The state agencies will continue to work to implement that plan as voters intended so enrollment can begin April 1.  Let’s focus on getting people the health care they need and deserve instead of increasing bureaucracy, red tape  and risks that help no one.

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Utah Decided: Implement Full Medicaid Expansion without Delay

On November 6, 2018, Utah voters took an historic step, voting to expand Medicaid to adults and families across Utah through Proposition 3. We call upon our Legislature and Governor Herbert to ensure that full Medicaid expansion is implemented by the April 1st deadline, without any delays or restrictions to care. Proposition 3 will help thousands of Utahns access affordable health insurance and was carefully crafted by healthcare and policy experts to ensure it would deliver on its promises. As Utah voters, healthcare consumers, providers and stakeholders, we stand by the following principles as full Medicaid expansion moves forward in our state.

Utah Decided: Full Medicaid Expansion is Fiscally Responsible

Utah voters approved a small sales tax on non-food items to fund Medicaid expansion. Numerous reports and analyses confirm that this tax increase provides enough funding to implement Medicaid expansion immediately and in a fiscally responsible manner. By expanding Medicaid, Utah will bring home federal dollars that have been set aside for our state. In addition, expanding Medicaid will create new jobs and grow the Utah economy. The hypothetical concerns raised about increasing long-term state costs will need to be monitored as the full economic picture becomes clear; however, these can be addressed and resolved in the future without delaying implementation or fundamentally changing the law.

Utah Decided: Full Medicaid Expansion Promotes Work

Medicaid expansion will help thousands of hard-working, low-wage Utahns get the health coverage they need to improve their lives. People cannot work if they are not healthy. Once the full Medicaid expansion goes into effect, we will have a more seamless public health insurance system that no longer disincentives work by creating an eligibility cliff for individuals and parents.  We support helping all Utahns find stable and productive work.  Medicaid work requirements will increase government bureaucracy and add to the cost of administering the Medicaid program, but, as has been shown in states where work requirements have already been put into place, will do nothing to help unemployed Utahns find work. 

Utah Decided: Full Medicaid Expansion Drives Healthcare Innovation

Medicaid expansion will allow Utah to reduce healthcare costs through improved access to primary and preventive care for all and strengthen our behavioral and physical healthcare systems by reducing uncompensated care. Many states are already delivering better-coordinated behavioral health and primary care services as a result of expansion. Utah has a strong history of healthcare innovation and, with expansion, Utah can continue to develop more efficient ways to provide services, find collaborative solutions for our state’s opioid crisis, improve the quality of care provided, and find better ways to address social determinants of health. Full Medicaid expansion will facilitate improvements to our healthcare sector that support growth and innovation.

Utah Decided: Full Medicaid Expansion Supports Strong Families

Medicaid coverage improves access to needed care for parents and children. When parents have health insurance, children are more likely to also be insured. Health insurance coverage strengthens families’ financial security and helps families avoid medical debt. Families with access to affordable health coverage are more likely to get the care they need to reach their full potential and thrive, and parents have the peace of mind they need to provide for their family.

We, the undersigned organizations, respectfully ask that our leaders implement Proposition 3 as it was written, making only essential technical changes. Voters did not choose to add restrictions or caps that will only delay implementation. For the health and well-being of all Utah residents, we must fully expand Medicaid on April 1st so Utahns can get the care they need to work, take care of their families and succeed. 

Sincerely,

AARP Utah

Action Utah

American Academy of Pediatrics, Utah Chapter

American Heart Association

Association for Utah Community Health

Bear Lake Community Health Center

Better Utah

Catholic Community Services of Utah

Catholic Diocese of Salt Lake City

Coalition of Religious Communities (CORC)

Comunidades Unidas

Crossroads Urban Center

Denials Management

Disability Law Center

Doctors for America

Epilepsy Foundation Utah

Equality Utah

Family Healthcare

FourPoints Health

International Rescue Committee

League of Women Voters of Utah

Legislative Coalition for People with Disabilities

Manufactured Housing Action

Midtown Community Health Center

NAMI Utah

The Children's Center

The Haven

The People’s Health Clinic

United Way of Salt Lake

Utah Academy of Family Physicians

Utah Chapter of the American Society of Addiction Medicine (UTSAM)

Utah Citizens' Counsel

Utah Democratic Healthcare Caucus

Utah Health Policy Project

Utah Housing Coalition

Utah Nurse Practitioners

Utah Nurses Association

Utah Partners for Health

Utah Statewide Independent Living Council

Utah Support Advocates for Recovery Awareness (USARA)

Utahns Against Hunger

Voices for Utah Children

YWCA Utah

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Voices for Utah Children is dedicated to increasing coverage and care for all Utah kids. With this comes the responsibility to rethink how our language can be more welcoming and inclusive. When referring to children who are eligible-but-unenrolled in public health insurance, but who may now enroll as a result of Medicaid expansion, the term “woodwork” or the “woodwork enrollment” is often used. This term suggests “to come or crawl out of the woodwork” according to the Oxford dictionary, and can have a derogatory connation. We believe a better phrase is the term the “welcome mat effect.” More children having access to health care is better for our state and allows children to be healthy and better able to reach their full potential. We are excited to welcome more children to these programs, especially as eligible but uninsured children obtain coverage thanks to Medicaid expansion for their parents.

Learn more here.

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U.S. Progress in Reducing the Rate of Uninsured Kids Stalls in 2017; Utah’s progress in reducing its overall uninsured rate halts too

Medicaid expansion is (still) the most effective way to move forward

Between 2016 and 2017, the U.S. uninsured rate for children remained flat at 5.4%, according to new Census data released today, after years of historic declines in the U.S. child uninsured rate.

Utah’s total uninsured rate, for adults and children, remained stagnant as well. Utah saw a slight increase from 8.8% in 2016 to 9.2% in 2017 (although data are not statistically significant). In previous years, Utah has seen a steady decline in its overall uninsured rate.

The gap in uninsured rates between states that expanded Medicaid, and states that have not, has grown in four straight years. If the uninsured rate had fallen in non-Medicaid expansion states at the same rate as it did in expansion states, another 4.5 million uninsured Americans would have had coverage last year.

In addition, Census data show continued disparities in coverage. In 2017, U.S. children in poverty had an uninsured rate of 7.8%, compared to 4.9% of children not in poverty. Among different racial and ethnic groups, Hispanic/ Latino children have the highest rate of uninsurance at a national average of 7.2%, compared to 4.3% among White children. (We'll have additional Utah-specific child uninsurance data available soon!)

Over the last several years, the U.S. and Utah have made significant progress reducing the rate of uninsured children. It is discouraging to see progress stall. Health coverage gives kids and families a healthy foundation and future. We will continue to work for all Utah kids and families to get insured and stay insured!

Medicaid expansion is the most effective way to help more children, parents and individuals enroll in health insurance programs, so we can continue to make progress toward helping all Utahns receive affordable health care. #YesonProposition3

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