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The current administration has made numerous changes to health care policy, and some affect Utah.

One that is important for Utahns to understand is what the Medicaid 1115-work mandate waiver that was submitted to CMS and HHS will actually do. This “work mandate” 1115 waiver will place restrictions on many adults who are currently receiving Medicaid up to the 100% federal poverty level (FPL) (family with 1 child $20,420/ yr. income) and or for those trying to receive Medicaid up to the 138% federal poverty level (family with 1 child $28,179/ yr. income).  Both groups will face greater barriers to coverage with this work mandate in place.

Examples of Utahns who would be affected are:

  • Food and service industry

  • Warehouse workers and low-income employment

  • Physical or mental health disabilities, people suffering from addiction

  • Education or training, speaking a first language other than English

  • Access to affordable reliable childcare and/or transportation

  • People working more than one part-time job

  • Those at risk for domestic violence

These barriers target low-income, less educated, and the elderly (ages 55-64) through a work mandate.  Medicaid enrollees’ statistics in the USA shows us that nearly 6 in 10 nonelderly adults (ages 19-64) are working, without being required to do so as a condition of coverage. People with disabilities may experience health issues related to their disability that prevent them from working consistently over time or from working every week.   Approximately 48% of non-elderly Utah adults (ages 19-64) with Medicaid have a disability but don’t receive a Social Security Income.  Nearly half of Utahns in rural areas receive a subsidy through the Affordable Care Act (ACA) or Medicaid.  The 1115 waiver's“work requirement” is a fancy term for “work mandate”; it is in fact designed to provide less coverage overall.  Utah children and parents will be caught in a poverty cycle. Utahns will be far less healthy than they would be with full Medicaid expansion through the Utah Decides ballot initiative.  

Other issues involving the 1115 Medicaid work mandate are that certain consumer protections that altogether eliminate or waive the state from following rules in regards to the Medicaid program.  The work mandate waiver request allows the state to Waive EPSD, which is; “the early periodic screening diagnosis and treatment”.  This is for specific for 19 and 20-year-olds. This also applies to Primary Care Network (PCN) and limited childless groups.

The Waiver allows “Time limits” on enrollment for PCN and adults without children. These populations will be limited to 60 months.  There will also be work requirements for PCN enrollees.Failure to complete these requirements will mean an enrollee loses coverage and no additional case management or patient education to help enrollees.  

This pending work mandate will also create budget caps, meaning once an enrollee hits the budget cap the State will decide what coverage or services they will cover. This specific budget cap list is still unknown to the public. The work mandate waiver also eliminates “hospital presumption” which is; “an individual can be temporarily enrolled in Medicaid immediately if it appears they are eligible. When an individual provides a hospital with a few basic pieces of information (about their income and household size), a presumption enrollment determination can be made”. This waiver also eliminates “retroactive eligibility” where patients can no longer retroactively get covered up to 3 months prior to enrolling into Medicaid.

The final issue with the 1115 working mandate waiver is that it could take years to be approved; we just don’t know the exact timeframe of approval. The best solution for Utahns on Medicaid is through the ballot initiative by The Utah Decides initiative. Their plan doesn’t come with the strings attached in the 1115 work mandate waiver and it covers all Utahns through the 138% FPL. This means 100,000 of our fellow Utahns in need will receive healthcare coverage.  This ballot initiative is funded without taking money from the state budget, the initiative needs 114k signatures by April 15th, 2018 to be put on the ballot. I would encourage all Utahns, leaders, and citizens to get behind the Medicaid expansion ballot initiative.  Together we can make a difference for our fellow Utahns in need.

Ryan Jensen is Vice Chair of the Democratic Healthcare Caucus.