SALT LAKE CITY — Utah and other Republican states are proposing to cut costs in the state’s Medicaid plan to cover the poor by requiring some participants to have jobs and limiting them to five years of coverage.
President Barack Obama’s administration rejected the restrictions in the past, but leaders in Utah and other states are proposing them again to take advantage of President Donald Trump’s offer to give states more flexibility. Officials in Arizona and other Republican-led states have made similar moves this year.
The changes come as Republicans in Congress work to repeal and replace Obama’s law, including some cuts to Medicaid, but it’s unclear how the proposals in Washington could affect Utah’s plan.
Instead of expanding Medicaid to more low-income people, as offered under Obama’s Affordable Care Act, Utah wants to take smaller steps to help a subset of the state’s poorest residents.
In a plan submitted to the Obama administration last summer, the state proposed insuring homeless people making less than about $600 a year or those who need mental health or substance abuse treatment, particularly those in the criminal justice system. Utah hasn’t received U.S. government approval for that plan, but it’s now moving to bring back the work requirement and coverage-limitation proposals that were sidelined by the Obama administration.
The state has also proposed capping the number of people covered by the program at 25,000 and stopping their coverage after five years. Officials also want to require a $25 copay for emergency-room visits that aren’t true emergencies.
The additional restrictions are open to public comment until July 20, and would be submitted to the Trump administration at the end of the month.
The proposal Utah is preparing for the Trump administration is estimated to initially cover 6,000 more people than the state covers under its existing Medicaid plan. But officials don’t yet know how much the expansion would cost, Utah Department of Health spokeswoman Kolbi Young said.
Critics, including low-income advocates, say the plan is harsh and creates roadblocks that could make it difficult for the poor to get help.
Micah Vorwaller, a policy analyst with the Utah Health Policy Project, a nonprofit advocacy group promoting affordable health care, said a lifetime limit can be a problem for the homeless and the poor because it can sometimes take people longer than five years to get back on their feet.
He said asking the poor to pay $25 for emergency-room visits can make a big difference in whether someone seeks care. Other advocates have pointed out a person may not know if a symptom like chest pain is considered an emergency situation and if they’ll have to pay extra to see a doctor.
“If you keep adding on new restrictions and trying to tamp it down, it just makes it harder and harder for those people who are already doing as much as they can to survive,” Vorwaller said.
Republican Gov. Gary Herbert believes proposals like a work requirement and 5-year limit will help control costs for the program so more people can take advantage of it and encourage and enable people to get back on their feet and become self-sufficient, according to his spokesman Paul Edwards.
“The governor feels quite strongly that the best thing that we can do for these individuals while providing a safety net is also helping to provide them with a job,” he said.