SALT LAKE CITY — Advocates for Utah’s homeless and mentally ill are questioning the Legislature’s partial Medicaid expansion plan after learning it will cover 6,000 fewer people than originally promised.
The proposal — signed by Gov. Gary Herbert in March and supported by Salt Lake City Mayor Jackie Biskupski and Salt Lake County Mayor Ben McAdams — was trumpeted as a compassionate strategy to cover 16,300 of Utah’s neediest, including 12,500 childless adults in extreme poverty and 3,800 low-income parents.
The Utah Department of Health is now estimating that the true number of individuals who can be covered is closer to 10,000.
That includes 6,000 to 7,000 childless adults in extreme poverty, according to spokesman Tom Hudachko — about half of what legislators originally billed.
Hudachko said the third-party actuaries hired by the health department believe the cost of treating such patients will be higher than what was anticipated by legislative fiscal analysts.
“We certainly recognize that this plan is not going to cover everybody that’s in the coverage gap,” he said. “That’s been known and expected since this legislation was originally envisioned. But I think what we can hang our hats on is that it’s a starting point.”
Rylee Curtis, a senior health policy analyst with the Utah Health Policy Project, called the revised estimates “shocking.”
“What was presented to the public is not what it’s turning out to be,” Curtis said.
“When groups were signing onto it, it was under the assumption that it was going to cover the 16,300 lives,” she added. “And now it’s not doing that any more. So I think that there’s a lot of concern among the community who’s been working on this the last four years.”
The Utah Department of Health released the plan for public comment last week. The department is responsible for drafting the final proposal and sending it to the federal government for approval.
To qualify, parents with dependent children cannot earn more than 60 percent of the federal poverty level. For a family of four, the income ceiling would be $14,580 per year.
For childless adults to qualify, they must be chronically homeless with a “disabling condition,” involved in the justice system through probation, parole or court-ordered treatment and in need of substance abuse or mental health treatment, or in need of substance abuse or mental health treatment.
The proposed income cut-off for those individuals is 5 percent of the federal poverty level — or about $594 a year for a single adult.
“This is a tough one for me because we all agreed to it,” said Jamie Justice, the executive director of the National Alliance on Mental Illness Utah, who said she fears the expansion may be too meager to make much of a difference for Utah’s vulnerable population. “Many of us supported it hoping that it would be a good first step toward a more comprehensive coverage in the future.”
Now she’s not so sure. Justice called the 6,000 lost slots a “huge drop.”
“This was supposed to be something to get people on coverage quickly and get them well,” she said. “I guess my fear is that we’ve said we’re creating a solution, but we’ve erected so many barriers around that solution.”
Salt Lake County behavioral health services director Tim Whalen said he sees the proposal as a “good faith effort” to chip away at the Medicaid gap, which includes some 53,000 Utahns who remain uninsured.