Utah's poorest of the poor are being targeted by a bureaucratic fix that would require them to enroll in a state health-care plan or lose the $261 they receive in state welfare each month.

So say advocates for the 17,000 homeless and disabled Utahns who believe those who receive general assistance but aren't enrolled in a health-insurance plan could simply be added to the state's Primary Care Network automatically over the next several months.

"You'd be very hard pressed to find a group of people having a tougher time," Bill Tibbitts, an advocate with Crossroads Urban Center, said after voicing his opposition to the rule change during a recent public hearing.

Lincoln Nehring, Medicaid policy director for the Utah Health Policy Project advocacy group, said the action amounts to penalizing people for not signing up for a program that doesn't help advance the goals of general assistance — to a better job or toward or back to self-sufficiency.

People receiving general assistance are childless adults who under doctor's orders are prevented from working for at least 30 days and have incomes less than $500 per month. Most have chronic health problems that have forced them to seek financial aid in the first place.

The state Department of Workforce Services is making the adjustment to a rule in its employment requirements to bring them into compliance with state law enacted when the old Utah Medical Assistance Program was changed to the Primary Care Network under former Gov. Michael Leavitt.

No decisions were made Monday night but department representatives who called the hearing at the request of Crossroads said comments will be taken into consideration as they work to clarify the requirements.

The rule change would close a client's case and the client would become immediately ineligible for further aid until PCN or other insurance coverage is obtained. Financial assistance is lost even if the client is unable to sign up because the PCN enrollment is closed at the time.

Gina Cornia, executive director of Utahns Against Hunger, said the rule is problematic because many of those on assistance are homeless because of their very low income levels or because letters notifying them of the changes and the $15 fee to enroll simply get lost.

"So they're finding out that they're ineligible when they meet with a job counselor," Cornia said. "It would be far less harsh and much more manageable administratively if they were automatically enrolled and the assistance just stays in place."

Advocates said some have even been in the hospital unable to enroll when told they are no longer eligible.

The rule change is more about the inadequacy of the state safety net programs, not making a rule change, the advocates said.

Enrollment in the Primary Care Network, the only health-care plan available to most on general assistance, is capped at 17,000 — about 10 percent of the population that is likely eligible for assistance.

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E-mail: jthalman@desnews.com