Can States Stretch the Medicaid Dollar Without Passing the Buck? Lessons from Utah
With the enactment of the Deficit Reduction Act of 2005, states have gained increased flexibility over benefits and cost sharing for certain currently eligible Medicaid populations without having to obtain a waiver of Medicaid rules. New findings from the Kaiser Family Foundation's 2004 survey of the experiences of Medicaid beneficiaries under Utah's 2002 waiver provide insights into the implications of limited benefits for the low-income population. The results are featured in the March/April edition of Health Affairs.
Under a waiver, Utah expanded coverage for primary care services to low-income uninsured parents and adults, offsetting costs by limiting benefits and raising cost sharing for poor parents, most with incomes below 54 percent of the federal poverty level, already covered by Medicaid.
The study suggests that a coverage expansion approach that relies on savings from reducing coverage for current beneficiaries and provides a limited benefit has important limitations. Although the primary care expansion helped fill a critical need for low-income uninsured adults, more than three-fourths of primary care enrollees needed services beyond the scope of their coverage. Similarly, more than two-thirds of the Medicaid beneficiaries subject to coverage reductions needed care beyond their coverage. The limited coverage or the cost associated with services, led one in three newly insured people to miss or postpone care and over half reported difficulty paying for medical expenses. Among the parents with coverage reductions, nearly a quarter reported missing or postponing care and over a third said they had difficulty paying medical expenses.
A case study report examining the creation and implementation of Utah's waiver through interviews with key stakeholders and an analysis of state enrollment data and quarterly reports is also available.