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State officials have identified unemployed Utahns on Medicaid who they believe are capable of working and intend to encourage those adults to get a job.
The idea mirrors a bill sponsored by Rep. Ronda Menlove, R-Garland, that would require some Medicaid recipients to do community service in exchange for their government-sponsored health coverage. Menlove pitched the legislation as a way to combat a "growing sense that the government should do more to meet people's needs."
Her bill that would direct the Utah Health Department to design and test-drive such a program drew spirited debate this week at an interim Health and Human Services Committee, which adjourned before voting it up or down.
When pressed, health officials acknowledged supporting the intent of the bill. Then Utah Health Department Director David Sundwall announced that he and his counterpart at the Department of Workforce Services, Kristen Cox, have been mulling their own fix.
Each year, Medicaid costs have soared at a rate that can't be sustained, consuming more of the state's budget, said Sundwall. Federal health reform is expected to steer 80,000 to 90,000 new adults into the program in 2014.
Most people join Medicaid rolls due to a financial or health crisis, and drop off when they find a job with benefits or wages that allow them to purchase private coverage, he said.
"But I have to candidly tell you, of the 225,000 enrolled now, there are some people who, probably by convention or custom, are on Medicaid and probably don't need to be," Sundwall said.
Using Workforce Services' new, powerful database of enrollees in state social services, he said, "We've been able to identify adults who could be working but don't … We have [identified] so many of these beneficiaries that we think we can give them a carrot to get them back into the work force or into [job] training."
The two department heads have a name for the program: People Who Can Work Do Work.
Sundwall said the program is Cox's brainchild. But Workforce Services is mum on the details.
"We're still in the early stages," said agency spokesman Curt Stewart, who said only that the program would be limited to adults, ages 18 to 64, who don't show up on the system as having a disability or wages.
Stewart couldn't say if the plan is to make work, job training or community service, as Menlove suggests compulsory. Nor did the agency produce documentation of able-bodied adults languishing on Medicaid. Most Utahns on Medicaid are children, pregnant women, seniors and adults with disabilities.
It's unclear whether Sundwall and Cox need the Legislature's blessing to start the program.
At Wednesday's meeting, lawmakers on both sides of the aisle bemoaned the rise of an "entitlement culture," but Democrats opposed Menlove's bill as punitive.
When Congress reformed welfare in 1996, requiring destitute Americans to work in order to get cash assistance, Medicaid was left out of the equation. The low-income health insurance program is a work support, not a handout, argued Rep. Luz Robles, D-Salt Lake City. "There's an issue of affordability when it comes to health care. Most people get onto the program because they can't get it anywhere else."
Said Rep. Joel Briscoe, D-Salt Lake City, "I feel there's a hidden agenda here, and the agenda is to move people off Medicaid. If that's the agenda, then let's talk about how to do that, about who should and should not be on Medicaid."
Republicans, too, questioned whether forced service is fair or even practical.
"Will this be voluntary or a requirement? Who decides who participates and who gets a pass? Do I wash dishes or do surgery?" asked Sen. Allen Christensen, R-North Ogden, who also wondered how much the program would cost to administer.
Menlove, a longtime advocate for people with disabilities, said the community service isn't meant to be a burden, but a pathway to new opportunities.
For people who are homebound, it could be a way to get engaged in the community, or pick up a new skill to be parlayed into a job, said Menlove. "They could tutor at schools, which have faced budget cuts and lost teacher aides."
One hurdle: Federal law dictates eligibility and forbids imposing special requirements on most populations.
But states have some leeway to tweak Medicaid eligibility for enrollees with incomes at 133 percent of the federal poverty standard, said state Medicaid Director Michael Hales. In Utah, that's limited to 5,000 of the 15,000 adults on the Primary Care Network (PCN), a bare-bones version of Medicaid that covers preventive care and some prescriptions.
More than half of all PCN enrollees already work, many for low wages and at businesses that don't offer health benefits. Most also pay up to $50 to enroll. Hales suggested using volunteering as a carrot instead of a stick.
"PCN is open for enrollment only every five to 10 months," he said. "We could allow people who agree to volunteer to come onto the program outside normal enrollment windows."
But some lawmakers are unflinchingly supportive. "The fact is we're providing people a health benefit at taxpayer money," said Orem Republican Rep. Brad Daw. "And we're asking them to do service that in monetary value is far less than the service they are receiving. How is that punitive?"
Taxpayers cover legislators' tab
Utah's 104 lawmakers, who are part-time officials, have access to state health insurance similar to full-time state workers and for the same cost. Additionally, unlike other state employees, legislators are eligible for lifetime benefits once they reach age 65 and have served four or more years, or they have reached age 62 and served 10 or more years.
The value is comparable to that of a year's worth of Medicaid, the government health coverage for low-income children, seniors and people with disabilities.
Lawmakers choosing the cheapest Public Employees Health Plan option offered in fiscal 2009 got coverage for a one-time, out-of-pocket premium of $91. The state paid the remaining $4,460 of the premium. Those covering their families paid a one-time sum of $251. The state paid the remaining $12,276.
Rep. Ronda Menlove, R-Garland, who is sponsoring a bill that would require some Utahns to do community service in exchange for Medicaid coverage, is not covered by PEHP. She gets coverage through her employer.