Uninsured Utahns in limbo as state leaders mull Medicaid expansion

SALT LAKE CITY — Health insurance mandates that require every individual to be insured go into effect early next year, but decisions yet to be made by state leaders have many Utahns hanging in the balance.

Approximately 377,700 Utahns are uninsured, up to half of those might qualify for Medicaid if the state opts to expand the program. But lawmakers and ultimately the governor are awaiting results of a report commissioned by the Utah Department of Health to determine whether such an expansion would be good for Utah's economy.

The report, facilitated by Boston-based Public Consulting Group, was commissioned in mid-December and was initially intended to be completed prior to the legislative session starting, but has twice been delayed.

On Tuesday, health department officials told lawmakers in the Social Services Appropriations Subcommittee that it could be another week or two before the data are ready for public consumption.

"It has stymied the process and set Utah behind many other states that already did studies and are moving forward with the expansion," said Matt Slonaker, Medicaid policy and collaborations director at the Utah Health Policy Project, a local advocacy group working toward affordable health care for all Utahns.

Medicaid expansion, he said, is "the big elephant in the room."

Dr. David Patton, executive director of the Utah Department of Health, said that following release of the report, a commission made up of community stakeholders will be tasked with digesting the information it contains.

"We are trying to be objective and trying to say what is best for Utah in terms of the costs and the benefits," he said.

If the state opts for expansion, it could take effect as early as January 2014, but it could also be implemented later than that, and federal reimbursement money would be left on the table.

The federal government, in compliance with the Affordable Care Act, is expecting to pay 100 percent of the cost of expanded coverage for the first three years of implementation and at least 90 percent after that, which would amount to more than $4 billion coming to the state in the first five years, according to a Kaiser Family Foundation study.

"That's pretty hard to turn your nose up to," Slonaker said. "Things like this don't come along very often."

The state, however, would also have to fund a significant portion of expanded coverage, including administrative and processing costs, as well as for care, to the tune of about $174 million over the next six years. It could end up being more, depending on pending federal budget decisions.

"There's a large array of things we're looking at, and we are making sure details are factored in for Utah's population," Patton said.

Other states are similarly studying potential economic impacts of a Medicaid expansion, and results "are all over the map," he said.

Projections by The Advisory Board Co., a global research firm that works with health care and education providers, indicate that 13 states have decided not to participate in a Medicaid expansion program, five are leaning toward not participating, three might expand and 23 are decidedly embracing the optional federal health care law provision to expand Medicaid.

Six states, including Utah, remain undecided on the issue.

Governors face no deadline for choosing whether to expand, but a decision would need to be made by about October if state leaders want to offer the expanded benefits in 2014, Patton said.

"If we don't (decide by then), we miss out on the federal match for that year," he said.

Currently, there are 258,866 Utahns insured by the Medicaid program.