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

Published: Thursday, Nov. 17 2011 6:30 p.m. MST

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.

"Our priorities here are really backwards," she said during a public comment period held Thursday on the program. It was the second of two public hearings to help officials refine the proposal that will be submitted to CMS pursuant to HB211.

Eligibility for the PCN program is looser than that of other state-run Medicaid programs. It is based on income, and assets are not included as they are when applying for Medicaid. PCN is intended to accommodate more single people who don't have other health insurance options through their employment or otherwise.

Sheila Walsh-McDonald, an advocate with the Salt Lake Community Action Program, said individuals who would qualify "are working populations" and likely don't have the time to provide volunteer service.

While the exact parameters of the community service remain undefined, Hales said that individuals interested in the PCN benefit under the eligibility waiver would be able to choose between working for a nonprofit, a school, or a business that could also provide limited training at no cost, in a specified area of the state — likely within Davis and Cache counties.

Hales said the eight hour per month stipulation, when considered at working wages, would largely offset the expenditures used to cover a PCN membership, which provides very limited health care coverage. Not to mention, he said, "people get intrinsic value  from contributing to society."

UDOH will continue to accept written comments on the potential waiver via U.S. Mail, to the Utah Department of Health, Division of Medicaid and Health Financing, P.O. Box 143102, Salt Lake City, UT 84114-3102, or by email, to cdevashrayee@utah.gov.

E-mail: wleonard@desnews.com

Twitter: wendyleonards

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