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Medicaid is under fire, with political leaders blaming the health safety net for state budget woes and runaway health-care spending.
Much of the angst stems from the fact that enrollment in the program swells in bad economic times, just as the pool of taxpayer revenue available to fund it shrinks.
But Medicaid spending in Utah declined this past recession — at least on a per-enrollee basis.
From July 2007 to June 2009, Utah's Medicaid rolls grew 55 percent as workers lost jobs and their health benefits. But per-patient spending on outpatient care fell 7 percent, according to new Utah Department of Health data.
Spending on nursing homes, prescription drugs and inpatient hospital stays also fell.
Health officials say policy changes have helped to keep costs in check, including the expansion of a preferred-drug list to steer patients to lower-cost medicines and a program to move people out of pricey nursing homes into home-based and community settings.
But those alone don't explain the downward trend, said Utah Medicaid Director Michael Hales, pointing to a shift in the mix of enrollees as another possible factor.
"During the downturn we started to see people coming onto Medicaid because they qualified for other public programs, [such as] out-of-work families, children and their parents," said Hales. These families have been slow to seek health care, because it was unemployment that drove them to apply for government aid, not medical problems, he said.
That squares with Ellie Brownstein's experience.
The University of Utah pediatrician sees a mix of patients and says privately insured parents have different health-care-seeking habits.
"They tend to think twice before spending the several hours it takes to go see a doctor, especially if they sense, 'They're just going to tell me it's a cold,' " said Brownstein. "They're self-treating when they should be."
Not always so for traditional Medicaid populations.
"It's probably a lack of experience or knowledge, but there's also no incentive to skip that doctor visit," said Brownstein, referring to the fact that Medicaid's co-payments top out at $3.
Budgetary relief is likely short-lived for Medicaid.
Spending on inpatient and outpatient care is inching up again, partly due to recent hikes in the amount that Medicaid pays providers and a bed tax that allows hospitals to draw down more federal funding, said Hales.
The health department analyzes spending each year. The report may underestimate spending since it spans the 70 percent of all Medicaid clients who receive care under fee-for-service arrangements. Managed care, which other enrollees receive, tends to yield greater savings.
Still, the program reflects national health costs, which continue to soar.
Costing $1.8 billion, Medicaid consumes 9 percent of the state's budget and is expected to eat up 13 percent by 2020.
"The current rate of spending is not sustainable," said Hales, who hopes a plan to extend managed care to more Medicaid enrollees will level or bend the cost curve.