Over 1/3 of Utah Medicaid enrollees have a disability. It is the largest publicly-funded program supporting Utahns with disabilities. Any cut harms Utahns with disabilities.
Medicaid is more than low-income health insurance. In addition to doctor’s visits, hospital stays, and medical equipment, it is frequently the only option for Utahns who need intensive mental health care or long-term services and supports not usually available in the private market
Medicaid has mandatory and optional populations and services. The only mandatory groups are parents, children, foster youth, older adults, and medically needy/individuals with disabilities, all of whom generally must have income at or below 133% of the federal poverty level. “Optional” services are not medically optional. It means a state is not required to offer a service. For example, physician, hospital, or nursing home care is largely mandatory. However, prescription drugs, much of mental health or substance use disorder treatment, and the home and community-based services described below are mostly optional. If Utah is forced to make tough choices, critical services like these are most at risk.
60% of Utahns enrolled in Medicaid expansion have a mental illness or substance use disorder. 30,000 have a mental illness and 19,000 have an SUD. Still, the state’s Office of Substance Use and Mental Health says public mental health and substance use providers saw almost 10,000 clients with no funding attached to them last year. Despite the obvious work remaining, over the last five years Utah wisely used its Medicaid expansion dollars to strengthen and expand its suicide prevention and crisis stabilization systems. It is now doing the same to reduce homelessness and criminal justice recidivism.
Medicaid supports Utahans with disabilities and those who are aging through:
- The Community Supports Waiver serves 6,000+ individuals with intellectual or developmental disabilities in supported employment, day programs, group homes, and more.
- The Community Transitions Waiver has allowed almost 500 people with intellectual or developmental disabilities to move from facilities into the community.
- The Limited Supports Waiver offers 126 families a few lower-cost supports designed to make it easier to continue to care for their loved one at home,
- The Acquired Brain Injury Waiver offers personal budget assistance, homemaker services, supported employment, and other supports to help over 160 people remain as independent as possible,
- The Physical Disabilities Waiver offers personal assistant services with activities of daily living such as transferring to or from bed, dressing, toileting, and showering to nearly 100 people.
- The Medically Complex Children’s Waiver provides Medicaid to about 900 Utah kids as well as respite care and case management for their families.
- The Technology-dependent Waiver (offers nearly 150 individuals who rely on a tracheotomy, ventilator, or other technology to survive feeding therapy, skilled nursing, and other services.
- The New Choices Waiver helps nearly 2,000 mostly assisted living residents avoid placement in a nursing home.
- Aging Waiver supports like emergency response systems, supplemental meals, home health aides, and companion/adult day services enable more than 350 Utahns to remain in their home.
The federal budget reconciliation resolution proposes $880 billion dollars in cuts to Medicaid. They could take a variety of forms:
- Work requirements: A KFF study found that more than 40% of non-SSI adult Medicaid enrollees are working full-time, with another 18% working part-time. Most proposals also exempt caregivers and people with disabilities. In 2019, Utah admitted that only an estimated 10% of expansion enrollees would likely be subject to its proposal. Unfortunately, people with disabilities often have a hard time accessing SSI and SSDI, making it challenging to demonstrate they should be exempt from a work requirement. In Arkansas, some 18,000 beneficiaries lost access to affordable and quality care, probably because a good number of them simply could not comply. A work requirement may not generate a good return on investment either. For instance, an Indiana proposal said it would cost $90/month to administer per enrolled member and constitute close to 16% of the coverage cost for enrolled members.
- FMAP changes: the Federal Medical Assistance Percentage is the match rate given to states. In Utah, the federal government currently pays about 64% of the cost for traditional Medicaid. It also covers 90% of the costs of Medicaid expansion. If that percentage drops, 83,000 Utahns with less than $1,800 in monthly income lose coverage.
- Per capita caps: a cap limits the amount the federal government will spend by giving states a set amount per person enrolled in Medicaid. Utah could be responsible for some or all the extra expense of enrollees who have or develop a condition with costs above the cap on the category to which they were originally assigned. This will almost certainly strain the state’s budget and lead to cuts in Medicaid or elsewhere.
- Block Grants: states would be given a set amount of money, Past proposals have been insensitive to things like population growth, the impact of natural disasters, or new and effective, but expensive, treatments. For any number of reasons out of its control, the state may find itself unable to meet the needs of all eligible Utahns within its grant. If this were the case, the first cuts would likely be optional populations and services.
We worry any of these choices will threaten even the modest progress made by Utah’s behavioral health system and strain our already overburdened providers further. We also fear that, especially with the aging of family caregivers and the challenge of recruiting and retaining a highly qualified direct care workforce in a competitive economy, Utahns with disabilities and those who are aging may be forced back into institutions.
What can I do?
Share stories with state and local leaders about how Medicaid has helped you or your loved one.
Follow our social media and stay posted for action alerts when specific plans to cut Medicaid are proposed.
Tell our federal delegation not to cut Medicaid.
- Use this form.
- Or Or call them at 866-426-2631 and tell them: Protect Medicaid. No cuts. No caps. No compromises.
- Provide public comments on the state request to add work requirements to Medicaid expansion (Community Engagement Amendment).
- Visit the Protect Medicaid Utah website for additional information.