State drafting a waiver to provide health insurance benefits in exchange for community service

SALT LAKE CITY — Community service in exchange for health insurance?

It's an idea that the Utah Department of Health is exploring to allow an otherwise economically challenged population to give back to their community.

Based on income, some recipients of the state's Medicaid health insurance benefit share in the cost by paying modest co-pays and premiums. A pilot program would offer the service option in exchange for health benefits for those who can't afford to contribute toward cost of Medicaid.

But the proposed program would first need approval by federal Centers for Medicare and Medicaid Services. UDOH has until the first of the year to submit a waiver to CMS that could change how Medicaid operates in Utah and allow the program.

If approved, up to an additional 100 Utahns, who are between 134 and 150 percent of the federal poverty level, would be able to enroll for Medicaid's existing Primary Care Network benefit. The program provides only primary and preventive care, including doctor visits, prescription medication and dental examinations, to eligible adults in the state. A certain percentage of those eligible must be parents, according to PCN rules and regulations.

The program, however, is nearly maxed out, at 14,755 enrollees, and with a two-week open enrollment period coming up in December, any available slots are expected to fill up quickly. While PCN typically holds an enrollment period once or twice a year, when availability opens up, the program hasn't accepted any new applications since November of last year.

The waiver is a result of HB211 that was passed by state lawmakers earlier this year. The waiver is being drafted to incorporate a plea for the changes that would help a voluntary group of Medicaid recipients to demonstrate an involvement in the community, according to Michael Hales, director of the state's Medicaid and health financing division.

He said that if approved, the program would require an individual to perform eight hours of community service each month to receive PCN benefits.

Essentially, the new provision would increase the amount of people the program can help, as it is otherwise bound by funding constraints.

However, opponents say that the administrative costs will be too great and realistically, "it is getting us so far from the basic need of health care for these individuals," said Utah Health Policy Project Director Judi Hilman.