"I had hoped to keep this savings for emergencies and necessary large expenses . . . things such as repairs to our water heater," Wilson said. "But when you're sick, nothing else matters."

Marjorie and Jamin Wilson and their two children, ages 4 and 5, represent the families who make up 85 percent of Utah's Medicaid rolls. They also are among the thousands of beneficiaries who lost dental and vision benefits during the 2001-02 recession.

The Utah Legislature recently restored those benefits. But low-income advocates fear those and other benefits are vulnerable as U.S. Health and Human Services Secretary Mike Leavitt encourages states to adopt a Medicaid innovation that he test-piloted while governor of Utah.

In 2002, Leavitt created the Primary Care Network (PCN), bare-bones health coverage for uninsured Utahns who earn too much to qualify for Medicaid.

To help fund it, the state reduced coverage for some traditional beneficiaries, imposed co-payments and relied on the generosity of doctors and hospitals to provide charitable care.

PCN is an asset for the young, healthy Utahns it serves. But the Wilsons show that losing so-called optional benefits makes escaping poverty more difficult and encourages longer-term reliance on government assistance.

Wilson, 27, grew up poor and has fought depression most of her life. Her husband, Jamin, also suffers from chronic depression. Together they have built a comfortable home in a double-wide trailer on Salt Lake City's west side.

But Wilson's dream of attending college and having a career dims each year as she struggles to keep her children clothed, fed and healthy. The Wilsons spend about 60 percent of their monthly $1,000 welfare payments renting their trailer slip.

"I find myself asking questions like, do I really need Kleenex? If I skip the Kleenex this month, I may be able to get batteries to run the learning toy my children got for Christmas," Wilson says.