The Future of Medicaid in Utah - Part 1: Understanding the Program

Jul 30, 2012

Utah lawmakers are faced with a big decision: to expand or not to expand the Medicaid program. But what do we know about the program? What do people in Utah think they know about the program? And what is life like for those getting help from the program have been transformed by Medicaid?  In part one of our series The Future of Medicaid in Utah, we set out to answer these and other important questions.

“Older people, freebies, handout’s,” says Salt Lake City resident Jeff Steal.

But Steal might have a bit of a simplistic view of the program.

First, to be clear, Medicare is a federal program designed to serve the healthcare needs of senior citizens.

Medicaid on the other hand is a federal state partnership that was created to help those in need who didn’t have access to health insurance. But it’s grown to serve other populations.

There are more than 250,000 people on Medicaid today in Utah, about two thirds of them are children. The program also serves pregnant women, about 2,400 elderly people in nursing homes, people with disabilities and low-income adults with children.

“I’m not sure that I really agree with it being for the younger people,” Lehi resident David Tigner says. “I think they should probably get their own insurance or get a job and get insurance.”

Currently Medicaid doesn’t cover most adults without children, but that could change if the program were expanded under the guidelines outlined in the Affordable Care Act. The expansion could mean 50,000 more Utahn’s would be eligible for Medicaid.

18-year-old year old Arthur Morris is an example of a young adult who can neither work nor purchase private insurance. He was born with a hole in his heart and had open heart surgery at just five months old. His mother, Margene Morris, says when he didn’t reach any milestones, like walking or crawling some genetic tests determined he had a rare chromosome disorder.

“He has severe speech delay, motor skill delay, sleep disorder,” Morris says. “He can have violent outbursts and he has mental retardation and recently he’s been diagnosed with autism spectrum disorder. So he’s been quite a challenge.”

The Morris family has been involved in the Neuro-behavior Home Program at the University and Utah for about eight years. They only have access to the program because Arthur is eligible for Medicaid. Here, Morris says Arthur has a team of specialists working on his behalf in ways that his pediatrician alone could not.

“He’s very violent and can have some real challenging behaviors,” Morris says. “So it’s been a world of difference to have a team of doctors who are familiar with what he’s dealing with.”

Although Arthur is not allowed to have personal funds of his own, the program didn’t take the Morris’ income into consideration.

“We didn’t have to be poor and broke, even though we were probably there, but no, they didn’t even consider that,” she says.

Nearly all private insurers’ exclude coverage from those diagnosed with autism or other mental disabilities. Morris says without Medicaid, her family would be paying more than $2000 a month out of pocket for Arthur’s Medication.

“We couldn’t have had any of the things that have made Arthur’s life so much better without Medicaid,” she says. “We couldn’t have afforded it. He probably wouldn’t be alive today.”

Arthur is an example of someone who will probably receive Medicaid indefinitely. But not everyone who benefits from the program requires that kind of long-term care.

Back in Salt Lake City, resident Tony Pruitt says Medicaid was originally designed to provide temporary help for those who are struggling.

“But it’s unfortunately become a permanent situation for a lot of people and therefor gets abused,” Pruitt says. “So it’s kind of sad and frustrating because it enables people to continue bad habits, instead of do something with their life.”

35-year-old Clarissa Blackmer exemplifies what Pruitt considers the original intent of the program.

Medicaid gave her the short-term support she needed to eventually become self-sufficient.  Blackmer had a series of medical issues manifest shortly after moving to Utah in her twenty’s to go to college. She suffers from fibromyalgia, rheumatoid arthritis and two heart conditions. On top of that, her sodium and potassium levels drop suddenly and randomly causing her to faint. While in school Blackmer capped out on her parents insurance after only a handful of trips to the hospital and was forced to drop out of school.

“I needed to have some stable medication,” Blackmer says. “I needed to constantly be seeing specialists and have the right specialists and for that I needed insurance. That was the only way I could physically be able to not be bedridden.”

With the help of Medicaid, Blackmer was able to finish school. And she did it quickly, receiving her bachelor’s degree in two years instead of four. She’s now a social worker for the state of Utah, working with people who are on Medicaid.

“I just am bound and determined to work despite the medical conditions,” she says. “I would rather be an example to others than just live off of the system.”

Blackmer says she’s nervous about the stigma surrounding the program.

“I work with families who desperately need it,” she says. “It will provide stability. It will keep kids in their homes rather than having to go into a system.”

Judy Hillman, Executive Director of Utah Health Policy Project, advocates for more access to affordable care.

“Anyone you go out to, an adult under 133 percent of the poverty [level] and you ask them, do you want to get into a job and into a place in your life where you can earn more money and therefore also be in private insurance and the answer is always yes,” she says.

But Hillman says they’re not going to get there without descent coverage. She says Medicaid is really a tool for them to get on and stay on that path to self-sufficiency.

Utah lawmakers have yet to make a decision on whether or not to expand Medicaid and offer coverage to a population that is currently uninsured. The federal government has pledged to cover 100 percent of the cost of that expansion for the first three years and after that they will pay up to 90 percent of the cost. State lawmakers expect to make that decision in the next Legislative Session.