Nearly 30K Utahns enrolled in newly expanded Medicaid, but some are left uninsured after feds refuse to extend Obamacare signup

(Trent Nelson | Tribune file photo) Stacy Sanford, health policy analyst for the Utah Health Policy Project, talks about Utah's "bridge" Medicaid expansion program at a news conference in Salt Lake City's Liberty Park on Monday April 1, 2019.

Enrollment in Utah’s partially expanded Medicaid program has grown to roughly 29,000 low-income residents, the state’s Medicaid director said Wednesday, with new applications screened on a “day-by-day” basis.

“We haven’t had, like, a spike or an explosion,” Nathan Checketts said. “It’s been a steady growth.”

Between 70,000 and 90,000 Utahns are estimated to be eligible for the program, which provides health care coverage to those earning up to 100 percent of the federal poverty level. Checketts said it could take up to a year to reach the 70,000 figure and five years to enroll 90,000 Utahns.

Another 40,000 to 50,000 Utahns could have enrolled in Medicaid under Proposition 3, a full-expansion program approved by voters in November that was subsequently rejected by lawmakers in favor of a more restrictive program. Under the Legislature’s plan — SB96 — those individuals earning between 100 percent and 138 percent of the federal poverty level are expected to buy subsidized insurance through the Affordable Care Act’s individual marketplace.

On Wednesday, during a hearing of the Health and Human Services Interim Committee, Salt Lake City Democratic Rep. Jen Dailey-Provost asked about anecdotal reports of low-income Utahns who expected to qualify for Medicaid under Proposition 3 and dropped their Obamacare insurance after last year’s election.

“Is there any remedy?” she asked. “Is there anything we can do to get those people coverage?”

Checketts responded that the state asked the federal government to reopen Obamacare enrollment for Utahns excluded by SB96, but that request was denied.

“Their overall policy and practice has been that they don’t offer a special enrollment period,” Checketts said.

After the hearing, Checketts said it is not known how many previously insured Utahns were left without coverage by SB96. The Affordable Care Act’s open enrollment period is typically held in late November and December, with plans purchased during that window taking effect in January.

“We don’t have any [Utah] figures because it is a federal marketplace,” Checketts said.

Stacy Stanford, a policy analyst with the Utah Health Policy Project, said her organization has heard from several Utahns who expected to enroll in Medicaid only to be left uncovered.

“If they could find a job with benefits, they’d have the job with benefits already,” Stanford said. “It’s not that simple.”

Stanford said her organization directs patients toward free clinics, but added that those facilities are often at — or beyond — capacity and typically offer only limited, primary care services. Stanford said she struggled herself to access free clinics when she was in the Medicaid coverage gap — a pre-expansion phenomenon in which people made too much money for traditional Medicaid but not enough for subsidized health insurance.

“These people are being left putting Band-Aids on bullet holes until they can get insured in January,” Stanford said. “So emergency rooms, free clinics and GoFundMe is the answer until January.”

Utah’s Medicaid program formally expanded on April 1 under the terms of a temporary program, known as the “bridge” plan, that sees the federal government paying 70 percent of the state’s costs. The state will soon request a federal waiver to operate its permanent program, which will impose work requirements on beneficiaries and potentially cap enrollment, with the federal government increasing its cost share to 90 percent.

The permanent plan also anticipates a per-capita cap, with federal funding based on the number of enrollees, rather than the medical needs of enrolled Utahns. Critics say that provision opens up the state to excessive costs, because all expenses incurred by patients beyond the per-capita cap would be fully borne by Utah without matching federal funds.

Checketts told lawmakers Wednesday that the state’s waiver application will likely include a request that any Medicaid expenses above the per-capita cap would be shared with the federal government on a traditional 70-30 split to provide a “buffer” to Utah’s budget.

“This is all draft [plans],” Checketts told The Salt Lake Tribune. “We’re still going through internal discussions.”

Stanford said that change, which is not part of SB96, illustrates the problems with a per-capita cap funding model. She said the committee discussion suggests state leaders are starting to recognize how capped federal funding would be “real rough on Utah."

“Once you hit that cap, the state is responsible for 100%,” she said. “That’s what they voted on. That’s what they chose to do."