Utah’s Medicaid Expansion “Stumbling Block”

Prior to his most recent trip to Washington, D.C., and then in further discussions with Health and Human Services Secretary Sylvia Burwell, Utah’s Governor Gary Herbert revealed a significant detail about his negotiations with expanding Medicaid in the Beehive State. For state legislators who must approve the final deal, it is a cultural and political distinction worth noting.

Utah policy makers believe that universal health care amounts to being on the public dole.

According to the governor, the “stumbling block” to Utah’s obtaining the expanded federal funds for Medicaid is a “work requirement” and has alternatively been referred to as a “work effort” that Utah policymakers believe must be a prerequisite to obtaining Healthy Utah (via Medicaid care) coverage. While this accompanying video from August 28th was recorded 12 days before his last meeting with Burwell, there is little change in the governor’s description of where the negotiations are at. With one small but significant exception.

On September 9, Herbert also said that there were “35 different issues that we’ve been negotiating with the Obama administration” that were on the table and that “25 to 26 have been agreed upon,” the same as was said in his monthly news conference in August. What was ever-so-slightly different was his statement that “[The effort] is to help Medicaid recipients, for those who are able-bodied, as an additional benefit.” The verbiage has currently shifted from “requirement,” to “benefit.”

But the stop at the Secretary’s office may be considered more than a courtesy call. Before taking her cabinet post, Burwell had been Director of the White House Office of Management and Budget, she was president of the Walmart foundation and president of the global development program of the Bill and Melinda Gates Foundation. A meeting of these minds would yield an agreement that is “unique to Utah… the only one in the union,” said Herbert.

According to a Utah Department of Health spokesman, the state is finalizing the details with HHS along the lines of validating benefits as is done with Temporary Assistance to Needy Families and the Centers for Medicare/Medicaid Services. No other state that has accepted expanded Medicaid funding has done this, according to the Governor.

At least 111,000 Utahns are interested in knowing what will happen next and when. Some of them go without life-prolonging treatments and drugs and all go without the quality of life that universal healthcare may afford. At the end of his teleconference on September 9, Herbert said that the final agreement with HHS was 2-3 weeks away, and was now in the hands of “the legal staff and policy people” for finalization. An agreement would allow the matter to be debated and endorsed by the Utah legislature and then Utah would receive the monies that have already been collected from its citizenry, to be spent specifically on Medicaid-qualified recipients under the Healthy Utah plan.

Also worth noting is that to qualify for unemployment insurance benefits, the State of Utah requires that a person contact four potential employers each week and document their efforts with the state’s Department of Workforce Services (DWS). Some offices of DWS enforce this requirement differently than others due to budget and personnel constraints. Some observers speculate that the Department of Health could now require linkage to the DWS database to similarly enable healthcare benefits.

The governor’s office confirmed Thursday that “The governor’s intention is to help people who apply for benefits through the Healthy Utah plan also take advantage of the job training and job placement programs that are already helping people. Those are run through DWS…this is about more than providing health coverage to those living in poverty; it is an effort to help them improve their situations so they are no longer dependent on these benefits.” If the state of Utah can appropriate less funds by applying these requirements as benefits, it becomes the “win-win-win” that state legislators might endorse.

Herbert said that federal and state staff were working together on specific language, that “the [Utah] concept is one that both sides agree with” and that the matter would be resolved by the end of September. The Utah State Legislature is ready to review the details and respond in the event that the Governor calls for a special legislative session to put everything in place.

The Utah House’s Chief Deputy, Joe Pyrah, responded to the latest announcement with “Sure. Show us the plan.”

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