SALT LAKE CITY — A proposed 60-month lifetime limit on Medicaid for certain adults drew concerns Monday from health care advocates at a public hearing on new eligibility guidelines set by state lawmakers in 2016.
Following the passage of a 2016 bill, HB437, the Utah Department of Health is preparing to implement new eligibility guidelines for the enrollment of vulnerable patients — namely homeless individuals and people with mental health and substance abuse issues.
The proposed changes to Utah's Primary Care Network would set work requirements for primary care eligibility, implement higher co-pays for those who go to emergency rooms for nonemergency care and set and enrollment limit of 25,000 people. The changes would also set a 60-month lifetime limit on adults receiving Primary Care Network benefits or Medicaid for adults without dependent children.
The proposed changes drew strong reactions from the audience at Monday's two-hour hearing at the Utah Department of Health.
"When you look at the medical problems in our community, it's a long-term endeavor," said Dr. Bill Cosgrove, a physician and representative for the American Association of Pediatrics.
Cosgrove said a system where care is disrupted, with patients losing eligibility or hitting limits, will slow the care goals set in place.
The existing health care system is already difficult and easily disrupted even with good insurance, he said, noting that further limitations will make it even worse for health care providers.
Stephanie Burdick shared her own experience struggling to get treatment after a 2015 surfing accident left her with a traumatic brain injury. Burdick noted the difficulty in continuing her rehabilitation schedule after losing her job and seeing her employer-based insurance run out.
When you look at the medical problems in our community, it's a long-term endeavor.
–Dr. Bill Cosgrove, AAP
Having difficulty meeting the Medicaid requirements, Burdick said she struggled to work through her rehabilitation and remain insured paying COBRA throughout the process.
Burdick noted that while she felt she was making progress toward recovery, unforeseeable costs arose.
"I had secondary head trauma due to visual deficits and balance issues," Burdick said.
Mary Jo McMillen, executive director for Utah Recovery Support Advocates for Awareness, said people with brain injury, mental disabilities or those under the influence of addiction have a hard time working through an involved enrollment process or demonstrating their eligibility.
"It injures the brain in ways we don't understand unless we have been there," McMillen said. "They have these services available but they are finding it difficult just getting there because of their emotional struggle."
McMillen said the 60-month coverage limit and the work-eligibility requirement would be especially difficult standards to meet for those who struggle with mental health and addiction problems.
Rep. Brian King, D-Salt Lake City, said the state's 2016 changes to Medicaid were frustrating, and though it represented an effort in the "right direction," the end result was "pretty lousy."
"I look at lifetime limits for the (Primary Care Network) and for adults without children and I just think those two things alone are incredibly harsh or at least have that potential to be incredibly harsh, especially for the people who need access to care the most," King said at the hearing.
Rep. Rebecca Chavez-Houck, D-Salt Lake City, joined King in raising concerns over the legislative effort made to revise Medicaid.
She said she was among several Democratic legislators that argued against only extending Medicaid benefits to a smaller, more-targeted population of the most vulnerable, because she saw benefit in extending coverage to the working poor.
Speaking at a meeting with the KSL and Deseret News editorial boards before Monday's health department hearing, Dr. Scott Williams of the Fourth Street Clinic said Utah's decision not to expand Medicaid during the rollout of the Affordable Care Act means the state will have to make difficult decisions about who will get funding for care among an already vulnerable population.
"We already have unmet needs in substance abuse and mental health that we are not funding," Williams said, who is the chief medical officer for the clinic.
The health department is still accepting comment from the public on the proposed changes until July 20. Comments can be submitted:
- On the website, health.utah.gov/medicaidexpansion
- By email to firstname.lastname@example.org
- By mail to:
Utah Dept. of Health Medicaid and Health Financing
PO Box 143101
Salt Lake City, UT 84114-3101
Attention: Jennifer Meyer-Smart.