Two years ago the Utah Legislature passed the Justice Reinvestment Initiative, designed to keep a person from entering or returning to jail or prison by providing him or her with community-based mental health and/or substance use treatment. More recently, Operation Rio Grande aims to provide the same kind of treatment to homeless individuals with similar needs.
Both projects rely on hoped-for funding from a yet-to-be-approved small-scale expansion of Medicaid. While it wasn’t perfect, most low-income community advocacy groups supported the effort as a step in the right direction. Now the state is proposing to put more requirements on those few who may eventually be found eligible. We fear the additional obstacles could undermine the original intent of the expansion, jeopardize the success of Operation Rio Grande, and waste taxpayers’ multimillion dollar investment in criminal justice reform.
The amendment puts a five-year lifetime cap on benefits, adds a 30-hour work requirement for supposedly able-bodied adults, and a $25 co-pay for parents and caretakers for incorrect emergency room use, among other things. Undoubtedly, these measures will most hurt those with chronic or relapsing lifelong conditions, those who can’t get enough hours to qualify for employer-based coverage or are struggling on minimum wage, and those who don’t have easy access to primary or affordable after-hours care.
The state contends the time limit is an effort to help most able-bodied adults without children find work by saying they expect these individuals will “do everything they can” to help themselves before they lose coverage. In reality, many have lifelong conditions which don’t respect arbitrary limits on access to needed care. Their health and safety will be unnecessarily endangered because of the state’s unjustified assumption about the work ethic of tens of thousands of Utahns.
The state also intends to impose a work requirement on a large number of the able-bodied adults enrolled in the program, despite a shocking lack of success with these requirements in similar programs. We’re left to believe the state’s assuming that individuals from the target populations do not seek work because they have minimal health coverage. However, no data or evidence suggests this is correct.
In fact, nationally, a significant majority of nondisabled, adult Medicaid enrollees are working at least part-time. The remainder are caring for loved ones, in school, retired, or have a disability which prevents them from working. A work requirement would only add to their already considerable burdens by requiring verification of compliance or exemption.
While the amendment states that the work requirement won’t apply to beneficiaries who are physically or mentally unable to work, the evidence from other states with similar requirements is that individuals with disabilities are often not exempted and are more likely to lose benefits.
Similar findings are no less likely in Utah, since a substantial share of eligibility determinations are made online or by phone, with little opportunity to interact with or assess the abilities of an applicant face-to-face. Work requirements will hit the very individuals we’re trying to help, those with chronic, relapsing, and/or disabling conditions, the hardest.
Research consistently confirms that co-payments harm low-income people by causing them to forego medically necessary care. While studies show that Medicaid recipients use the emergency room more than persons with other insurance, they also show enrollees are in poorer health and that most visits are appropriate. Moreover, studies of Medicaid and the Children’s Health Insurance Program have repeatedly demonstrated that nonemergency ER co-payments are ineffective at reducing nonemergency ER use.
It’s hard to see how discouraging people from appropriately using the ER is worthwhile, especially when the state doesn’t have a fully functioning system of alternatives for affordable and convenient off-hours care, such as health homes, integrated physical and mental health care, or easily accessible urgent care. In fact, it’s counter to everything the Department of Health has previously done to successfully reduce inappropriate ER use.
In keeping with the conversation around the future of the Rio Grande area, we call on Gov. Gary Herbert to withdraw the requested amendments. Instead, he should seek fast-track approval of the original request. If Utah’s serious about helping those returning to their communities or experiencing homelessness, making it easier, not harder, to get care is the first step.
A public information session on the proposed Medicaid expansion plan has been organized by several community groups. It will be held at the downtown Salt Lake City Public Library at 6:30 p.m. Monday. The Disability Law Center is also conducting an online survey at http://disabilitylawcenter.org/health-care/. The federal comment period closes Sept. 30.
Andrew Riggle is the Disability Law Center’s public policy advocate and Bill Tibbitts is associate director of Crossroads Urban Center.