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Business leaders, lawmakers, health care industry experts and advocates for the poor and disabled gathered at the capitol Tuesday to begin analyzing options for expanding — or not expanding — Utah's Medicaid program next year.

Widening Medicaid eligibility is an option under the federal Affordable Care Act as a way for states to extend health care coverage to more low-income, uninsured residents. An expansion would add about 131,000 Utahns to the Medicaid rolls, according to estimates from the Utah Department of Health.

Under the ACA, the federal government would cover 100 percent of expansion costs for the first three years. States and counties will have to pick up a share of the expense beginning in 2017, although the law caps those expenses at 10 percent of the total costs.

Initial estimates from state fiscal analysts indicate Utah could save money in the early years of expansion, but by 2021 would need about $60 million to fund the program.

Many of Utah's conservative lawmakers oppose expansion. Advocates for the poor and disabled and many health care providers favor expansion.

The decision rests with Utah Gov. Gary Herbert, who asked the state health department to convene the Medicaid Expansion Options Community Workgroup to explore possible cost-effective alternatives that could provide coverage for the uninsured.

"The governor and the state and the Legislature have a huge decision to make. It's exceedingly complex, it's not just a yes or no answer, it has a lot of implications," Lt. Gov. Greg Bell told the 20-member workgroup. "It's also a chance to lead out. Utah can do something very innovative that is also compassionate and economically sensible."

Utah is among five states that have yet to decide on expansion. A handful of states have proposed and received at least tentative approval for other ideas, such as Arkansas' plan to use federal money to buy private insurance for low-income residents.

An Arkansas-style plan, along with ideas for block-grant funding, tax recovery, state self-reliance and a partial Medicaid expansion are among the proposals the Utah workgroup and its subcommittees will consider over the next several months. Each analysis is expected to detail plan features, ways to cover the costs and a mechanism for addressing the needs of anyone that might still lack access to affordable coverage under the proposal.

"If there are other options out there, we are open to that too," said Utah Department of Health Executive Director David Patton. "Let's come up with a Utah solution and then take that to the feds and see how it goes."

The workgroup will also consider the results of a state-commissioned report by the Public Consulting Group. A draft of the report, which provides a cost-benefit analysis of full Medicaid expansion, was initially provided to state health officials in February, but is undergoing revisions. Patton said he hoped to have the report by the group's May 23 meeting.

Rod Betit of the Utah Hospitals Association is among those asked to sit on the workgroup.

"I'm very supportive of this process," Betit said. "To me, it could lead to a consensus about what we are willing to do and how we can get there."

Bell called on committee members not to lose sight of the Utahns that will be affected by whatever decision the state makes.

"We talk at a 30,000 foot level, at a policy level ... but at the end of the day, this is about a mom and a child and a family with a crushing burden of debt, or a family dealing with disabilities and we need to help," he said. "We have not filled in all the blanks, nor should government do everything, but we need to help in those situations that are worthy of our compassion."