Sep 19, 2022 - News

Low-income Utahns still aren't enrolling in Medicaid

Illustration of a hundred dollar bill puzzle with pieces missing out of the center in the shape of a red cross

Illustration: Sarah Grillo/Axios

New census data suggest a lot of Utahns who are eligible for Medicaid aren't getting enrolled — even after the state fully expanded coverage.

Driving the news: Utah had the nation's lowest rate — by far — of public health insurance coverage among kids from low-income families (less than $53,000 for a family of four).

  • About 42,000 Utah kids from low-income families have no health insurance at all — nearly 15%, the third-highest rate of any state.
  • Of Utah kids who meet the family income requirements for Medicaid, no more than 84% have public insurance, an Axios analysis of new insurance and poverty data shows.
  • That's a lower rate than any state except Wyoming, which hasn't expanded Medicaid and has much more severe income restrictions.

What's happening: Utah's low rate of Medicaid coverage appears to have persisted even after extraordinary growth in enrollment after Utah expanded coverage in 2020.

  • Utah had the highest growth in Medicaid coverage of any state after 2020, according to a study last year by the Urban Institute.

What they're saying: "We should have made up some lost ground, but compared to our peer states, I could see how we're still at the bottom," Matt Slonaker, director of the Utah Health Policy Project, told Axios.

The big picture: Utah for years has had one of the highest rates of people who are eligible for Medicaid but aren't enrolled — and some of the reasons for that aren't bad, Slonaker said.

  • Utah has exceptionally low health insurance premiums, which makes private insurance more accessible than it is in other states, he said.
  • Enrollment in ACA Marketplace plans is also growing more rapidly in Utah than in most other states, according to Kaiser.

Yes, but: It's likely that Utah is still recovering from "mixed messaging" during the state's halting Medicaid expansion process, Slonaker said.

Catch up quick: Utahns went through years of back-and-forth as to how stingy the state's Medicare coverage would be.

  • Voters in 2018 approved making Medicaid available to about 150,000 more people. In exchange, the state would get more federal funding.
  • But legislators in 2019 undid voters' efforts, only extending Medicaid to Utahns below the poverty line, and adding work requirements and an enrollment cap. But the state still wanted the extra federal funds.
  • Federal regulators denied the funding boost, which only went to states that raised the income cutoff to at least 138% of the poverty line — about $38,000 in 2022. After that, Utah enacted full Medicaid expansion.

The latest: Medicaid enrollment has continued to grow sharply in Utah during the first half of 2022, according to state data, so we could be catching up to other states.

  • But keeping people on Medicaid has been easier since 2020 due to automatic re-enrollment during the pandemic. The rules are scheduled to firm back up next month, which could drop a lot of families from coverage.
  • When automatic Children's Health Insurance Program (CHIP) renewal ended in April 2021, 41% of Utah recipients — more than 6,000 kids — lost coverage, in part because the state couldn't find them after a year of lost contact, health officials said.

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