Update: BYU-Idaho has reversed its decision and apologized “for the turmoil caused by our earlier decision.” Read our update here.

Casey Wilson took some time off from school last year when she found out she was pregnant with her second baby boy.

The young mom had hoped to miss only a semester or two at Brigham Young University’s campus in Idaho. She was just a few credits away from earning her degree in art education and set a goal of finishing before Kelvin, who’s 4 months old now, started to talk.

But before Wilson could sign up for classes beginning in January, as she planned, the college announced it no longer would allow students to enroll with only Medicaid as their health insurance.

And now, she can’t afford to return at all.

“I am devastated,” Wilson said, choking back tears as her baby cooed in her arms. “I love school. I want to graduate. But we’re a struggling family, and we don’t have the money for [private insurance].”

The controversial decision from BYU-Idaho — a private school owned by the Utah-based Church of Jesus Christ of Latter-day Saints — came as a surprise to students last week. School administrators announced the change in an email one day after Idaho received approval letters from the federal government for its Medicaid expansion plan, which voters in the state overwhelmingly supported last year.

As many universities do, BYU-Idaho requires students to have health insurance before they can register. Previously, Medicaid qualified as adequate coverage. But now, students with Medicaid as their primary insurance, the school said, would have to either buy another health care plan on the private market or sign up for coverage at the campus’ Student Health Center.

Plans there — which are administered by Deseret Mutual Benefit Administrators, established by the LDS Church — cost $536 per semester for an individual or $2,130 for a family. Medicaid is free or low-cost coverage for low-income people who qualify.

Wilson and her husband, Tanner, who’s also a student at BYU-Idaho, are both on Medicaid, as well as their two sons. Many college students who aren’t working while they finish school and who have families to support are eligible.

Without it, the 24-year-old Wilson said, they wouldn’t be able to see a doctor.

Already, they can barely afford the rent on their tiny apartment in Rigby. “And it’s infested with mice,” Wilson said. They scrimp on groceries, too, even with some help from family. But there’s nothing left in their bank accounts by the end of each month. And most of what they have to spend is from loans.

“There’s just not $500 sitting around for us to buy insurance from the school,” she added.

Tanner is getting his degree in software engineering and is slightly closer to finishing than Wilson (though the couple had hoped to graduate together). Now, Wilson said, it’s likely he’ll continue going to school while she stays home and watches their kids. That way, she and the boys can stay on Medicaid and they’ll only have to pay for Tanner to get the school’s health insurance.

They’re praying he can get a well-paying job when he’s done.

“We both came from poor families. And we wanted to go to school and get degrees,” she said. “I don’t want to be someone who has to rely on Medicaid my whole life.”

Many others at BYU-Idaho face a similar dilemma. So far, there aren’t a lot of answers.

Coverage concerns?

The school, which sits in the small town of Rexburg, has largely refused to explain the change. When reached by The Salt Lake Tribune for comment, spokesman Brett Crandall said he is “not conducting any media interviews.”

Wilson has called the Student Health Center several times, too, and each time she was put on a list and never heard back from anyone. When The Tribune called there, a receptionist said the center is not commenting. And the LDS Church referred all questions back to the school.

“This one I would defer to BYU-Idaho,” spokesman Eric Hawkins wrote in an email that inquired whether the policy was supported or encouraged by the faith’s leaders.

Meanwhile, BYU’s main campus in Provo is not instituting a similar policy — even with Utah pursuing its own Medicaid plan, which might end in a similar expansion. “We do not anticipate any changes,” said spokeswoman Carri Jenkins.

The faith generally encourages its members to obtain government help for which they qualify before asking the church for assistance. Some BYU-Idaho students told The Tribune that staff at the Student Health Center believed the Church Board of Education in Salt Lake City made the decision. Other students and church members have wondered on social media whether BYU-Idaho doesn’t support students using Medicaid coverage because it covers birth control, abortions in extreme cases and some services to assist transgender individuals in transitioning.

The church condemns “elective abortion for personal or social convenience" but permits the procedure in cases of rape or incest, severe fetal defects, or when the life or health of the mother is in serious jeopardy. Birth control is considered to be a matter between a couple and the Lord. But the faith holds that members are defined by their “biological sex at birth.”

BYU-Idaho is the largest private university in the state and has roughly 20,000 students. About a quarter, or 5,000, are married. Many of those are likely on Medicaid and more will qualify with the expansion. Coverage in January will stretch from those earning less than 100% of the federal poverty level to 138% of that amount.

After continued pushback from students, the Idaho campus sent out a second email Wednesday, suggesting for the first time that the decision was based on the state’s Medicaid expansion and a concern that students would overwhelm health care providers in the area.

The email said: “Due to the health care needs of the tens of thousands of students enrolled annually on the campus of BYU-Idaho, it would be impractical for the local medical community and infrastructure to support them with only Medicaid coverage.”

The Idaho Department of Health and Welfare disputes that reasoning.

While Rexburg sits in Madison County, which does have the highest concentration of potential Medicaid expansion enrollees in Idaho, the state has assured residents that providers have prepared for the expected wave of new patients. There are plenty of doctors in the region, said Niki Forbing-Orr, spokeswoman for the state health department.

“As far as we can tell," she added, “there shouldn’t be any kind of problems with access for those folks.”

An estimated 91,000 residents statewide could qualify when Medicaid expansion takes effect in January; nearly 2,400 live in Rexburg. It’s a lower-income community in eastern Idaho with a population of nearly 30,000, where roughly 42% are considered as living in poverty, based on statistics from the U.S. Census Bureau.

The college town has few job options for its predominantly white population. And many students go to BYU-Idaho specifically because of the cheap tuition — which the university’s president, Henry J. Eyring, touted in his inaugural speech.

“The school prides itself on being affordable and not requiring students to get loans,” said Connor Pack, a 26-year-old there studying music education. “This policy just runs counter to those ideals.”

Pack, his wife, Laura, and their daughter use Medicaid. Laura graduated in 2017, but Pack’s still got three semesters left. They’ve stayed in Rexburg for him to finish, but now they’re wondering if they can afford it or if they should move elsewhere where there might be more opportunities.

“I’m definitely worried about finding the money,” Pack said. “We’re barely breaking even as is, and we’ve got another baby on the way.”

Pack has joined hundreds of students in protesting the change. They’ve called and emailed administrators. But they haven’t gotten responses. They’ve posted on the school’s social media pages. But those comments have been deleted. Now, they’re planning a sit-in for Monday outside the offices for executives at BYU-Idaho. And they’ve started a petition that has more than 7,000 signatures.

“What place do they have to tell me what insurance I can and can’t have? If my insurance is federally acceptable then it should be acceptable for the school, too,” said Tanner Emerson, a senior in civil engineering.

It ‘blindsided us’

Many students have said they’re frustrated to have to pay for the school’s insurance when they’re already covered under Medicaid. Some have questioned whether the university or the church is trying to make more money from them. The BYU-Idaho plans might have seen a drop in enrollment as some newly qualified students switched over with the Medicaid expansion.

Deseret Mutual Benefit Administrators, or DMBA, is a private, nonprofit trust that manages benefits for many church-owned enterprises. Since it’s not an insurance company, it doesn’t have to comply with federal requirements for coverage. Its health plans are not considered minimum essential coverage under the nationwide Affordable Care Act.

DMBA plans at the school have a $370,000 annual cap on care — while limits such as that have been banned under federal plans. They don’t include care for pregnancies for a student’s spouse who doesn’t go to school, which many of the families on Medicaid need. And birth control is not covered either.

So some of the students who are signing up for the school’s plans don’t expect to use them.

“They can’t treat any single one of my medical diagnoses,” said Jessica Knoeck, 35, who noted she has severe rheumatoid arthritis, fibromyalgia and lupus and planned to return to BYU-Idaho in January when she qualified for the Medicaid expansion. “Buying their medical plan makes no sense.”

Emerson and his wife, Amanda, have one child and are expecting another in April. He’s working 20 hours a week in maintenance to earn enough money to cover their rent, which is already subsidized by the government. And they’ve both got federal grants helping to pay for tuition.

“This imposes a financial burden that doesn’t really seem necessary,” he said. “It happened overnight, came out of nowhere and blindsided us.”

For Andrew Taylor, the extra expense is so high and so unexpected that he said he has to drop out of school. “We really can’t afford this.”

He and his wife are living paycheck to paycheck already — and they’ve missed their last phone bill and aren’t sure how they’ll cover their next rent payment. She’s close to graduating, but he’s just starting. Now, he’s looking for a job to help her get through school.

“This is a way that they are trying to discriminate against people of low socioeconomic status,” he believes.

Kaleigh Quick said that she and her husband, Matt, have already deferred a payment on their car so they could get their kids Christmas gifts. Now, they’re worried they’ll have to use that money for the insurance at BYU-Idaho so Quick can finish her last seven classes.

Kris Lasswell, a sophomore in earth science, hasn’t been to a doctor in four years because he hasn’t had insurance. He’ll qualify for the Medicaid expansion in January. But with his wife, Naomi, expecting a baby and rent going up, he said he can’t afford BYU’s $500 insurance on top of that.

“It would mean the difference of me being able to live here and go to school or not being able to go to school at all," he said. “It’s the difference of me being able to pay rent or be homeless.”

Reclaim Idaho, a group that has pushed for Medicaid expansion in the state, condemned the school in a statement this week for its “unexplained decisions” to strip students of health care coverage.

“The vast majority of students and families we’re hearing from can’t believe the university would make such punitive decisions without explaining why,” said Rebecca Schroeder, the group’s executive director. “In one paragraph in a press release, they dropped a bombshell on hundreds, if not thousands, of students and are wiping their hands of the issue.”

Wilson said the lack of answers has been one of the most frustrating parts of the change. But she’s more disappointed that she won’t have a degree.

She wanted to show her sons that even though she grew up without much, she pushed herself through college. She’s not sure if that will happen anymore.