Most people agree that health care is too expensive, making the cost of accessing even the most basic care out of reach for many low-income Utahns.

AARP Utah as worked closely with health care advocates in Utah to make sure “safety net” programs such as Medicaid are kept affordable for the most vulnerable people in the state. This work has already begun, as the Utah Department of Health filed a “waiver” with the Centers for Medicare and Medicaid Services (CMS), asking if it could change the way it delivers services to Utahns that differs from the federal plan.

AARP Utah has worked closely with the Utah Health Policy Project on reviewing the waiver, which summarized concerns in a June 2011 position paper, Better Care for Medicaid Patients: What it Takes, as follows:

A critical step in a multi-year process to modernize the way Medicaid services are paid for and delivered in Utah [is] by organizing providers into accountable care organizations. ACOs are groups of health care providers who agree to be held accountable for improving health care quality while lowering costs. . . . the June 1 waiver draft places the "accountability" squarely on the beneficiary in terms of increased cost sharing, penalties for noncompliance (i.e. disenrollment) and drawing clients into private insurance via subsidies. Nothing in the waiver seems to acknowledge the need for certain services, like care coordination, health education, transportation, etc., as necessities to help patients comply with care recommendations.

Utah’s proposed Medicaid cost sharing schedule off the charts compared to other states. While inappropriate use of emergency rooms is a problem, and we agree that the co-payment schedule for this is reasonable, we are concerned with other features of the proposed cost sharing schedule. An annual per family $40 deductible can be a great hardship for clients. Add to that the co-pays for doctor visits and prescriptions, and a family could easily be priced out of access to medically necessary care. Cost sharing at this level has been shown to decrease utilization of cost-effective care, possibly undermining the goals of accountable care. If families cannot afford the deductible and co-payments they may delay care and be forced into the emergency room, limiting the savings that can be achieved through accountable care.

We will continue to monitor the status of the waiver so that changes to Medicaid keep the program fair and affordable. Medicaid is used by many on a short-term basis when their economic situation is dire and no alternatives are available; it needs to survive as a safety net for those in the greatest need.