SALT LAKE CITY — The Beehive State's approach to Medicaid reform incorporates consumer choice and individual responsibility, according to the governor. But it also goes against the federal government's new recommendations to manage costs.

Gov. Gary Herbert joined other governors and Utah Sen. Orrin Hatch on Thursday to continue in a fight for flexibility in dealing with national health care reform mandates. They each believe states could better handle a lump sum of money, even if it was cut, to have individual oversight of Medicaid.

"We have a plan that addresses our unique challenges and will fundamentally change the way Medicaid services are delivered to Utah citizens," Herbert said during the U.S. Senate Finance Committee Field Hearing held Thursday at the state Capitol.

Herbert outlined provisions of a waiver that was submitted to the Centers for Medicare and Medicaid Services, a federal agency, which administers Medicare, Medicaid and the Children's Health Insurance Program, on July 1. He said that in order to make that plan work, "the federal government needs to provide Utah with the flexibility to institute the plan."

As it stands, any changes to the way Medicaid is managed or delivered must go through CMS first.

"Solutions for sustainable Medicaid reform will come from the states — not just Washington," Hatch said. "My goal is to empower the states to design and implement innovative Medicaid solutions that work for the states."

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Utah was in an international spotlight of sorts Wednesday, playing host to US-China 2011. It's a major conference aimed at improving relations between the two superpowers at the state and provincial levels.

In May, Hatch asked individual governors for their ideas on Medicaid. He said he hopes to pool their answers to emphasize that the Obama administration's "one-size-fits-all approach to Medicaid reform" doesn't work for the diverse populations in each state.

"The governors understand their states best," he said.

From May 2007 to June 2011, Medicaid enrollment in Utah grew 51 percent, to 244,470 individuals. Costs already incorporate nearly 20 percent of the state's budget. Herbert said enrollment isn't the only thing to blame, but rising health care costs.

"It's time to move away from the entitlement mentality that has gotten us into this situation by requiring recipients to shoulder a little more of the financial load," he said. Utah's waiver, submitted to the federal government, increases co-payments for Medicaid participants for both office and emergency room visits, however, the system would be set up to encourage patients to seek care in the appropriate settings and provide incentives for such behavior.

Herbert said he believes private health insurance companies would follow suit, helping to drive down costs for everyone.

Mississippi Gov. Haley Barbour, also a republican, was also in town and joined Hatch in his plea for flexibility. He said several working and efficient health care programs in his state have been halted while waiting for approvals from CMS. Businesses are also holding off on new hires, Barbour said, because they are unclear on what insurance will cost for those employees.

"We don't want to have forced on us what happens to work someplace else," he said. "If the federal government wants to have a federal health program, they ought to pay for it."

Hatch denounced creators of "Obamacare" for not involving states, and called its mandates "unrealistic."

Medicaid, as it is, is unsustainable and is "crowding out other critical needs in state budgets, such as education and law enforcement," Hatch said. He heard from 29 different governors on the matter and is reaching out to them.

"There just has to be a better way," he said. "As it currently exists, Medicaid threatens the fiscal integrity of the nation and the states, and it fails to provide an adequate quality of care to those who depend on it."

Barbour emphasized the different circumstances each state has to face, but said "our ideas about Medicaid are quite similar."

Email:wleonard@ksl.com

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