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A proposed tightening of the work requirements for Utahns who receive food stamps could complicate the state's push for federal flexibility with its Medicaid expansion.
Able-bodied adults must spend at least 20 hours a week working or in job training in order to receive food stamps, after an initial three-month grace period. A loophole gives recipients the option of volunteering at certified "work sites," such as food pantries, instead of working in a paid job.
The state is considering closing that loophole and possibly applying the same work requirements to Utahns covered under a Medicaid expansion.
"We're not changing the work requirement; we're just removing the option to be at a work site. It's a matter of how we use our resources," said Kathy Link, who manages Utah's food stamps, or the Supplemental Nutrition Assistance Program (SNAP).
The plan, said Link, is to beef up an employment counseling program by providing more one-on-one help with job searches, resume writing and interview skills.
"We've had better outcomes with our Employment and Training [participants]," she said, noting that 48 percent of those who start the program find paying jobs within a quarter, many of them earning enough to no longer need food stamps.
Low-income advocates, however, fear the new rules will hurt hard-to-employ populations, such as the chronically homeless and former inmates who would suffer a double-blow if the same rules are adopted for Medicaid.
Thousands could be cut from public benefits, said Bill Tibbitts, associate director of Crossroads Urban Center, Utah's largest food pantry. "We know [the work requirements] cut people from the program because they were suspended by the feds during the recession and then reimposed in Utah a couple of years ago."
Utah is among 24 states that have yet to expand Medicaid as called for by the Affordable Care Act. Republican Gov. Gary Herbert is instead negotiating with the Obama administration for permission to use public Medicaid dollars to buy private coverage for an estimated 111,000 Utahns, mostly poor, uninsured adults.
Additionally, Herbert wants enrollees to pay up to $420 a year toward their health care and adhere to the same work requirements as food stamp recipients.
"It's on the table for consideration along with other options," said Department of Health spokeswoman Kolbi Young of the closed-door negotiations.
Chances of Herbert prevailing on the work requirement, however, may be slim. "It would be radical shift in policy to approve that type of work requirement, and current [federal] law doesn't allow it," said Lincoln Nehring, a health policy analyst at Voices for Utah Children. "You can't make Medicaid contingent on work. What you can do is assist recipients with job training services ... but you can't use federal Medicaid dollars for those services."
Indeed, in 2010 the feds shot down a 2010 legislative proposal to test-drive requiring some Medicaid recipients to do community service in exchange for their health coverage.
If the government is paying for your medical care, you should be expected to give something back, said Rep. Ronda Menlove, R-Garland, of her plan to combat "a growing entitlement culture" she feared would worsen with federal health reform.
As proof, she cited the problem of wealthy college students using Medicaid to fund their prenatal care and deliveries. "Is it my responsibility as a taxpayer to pay for that person to have a baby? Or could that money be better used for other purposes?" said Menlove, referring specifically to underfunded services for people with developmental disabilities.
Consumer groups, however, argue most about two-thirds of Utahns who would benefit from the Medicaid expansion already work, or worked within the past year.
They're employed in a range of industries, from food service and construction to transportation and child care, according to an analysis of federal census data by Families USA and the Utah Health Policy Project (UHPP).
Those who can't find employment tend to be struggling with mental illness or substance abuse, but don't quite qualify as disabled, said Tibbitts. "The economy has improved and the unemployment rate has fallen, but some of the people we serve here at the food pantry are the last people to be employed."
Herbert's 'Healthy Utah' proposal
Utah Gov. Gary Herbert wants to use public Medicaid dollars to buy private coverage for an estimated 111,000 Utahns with incomes up to 138 percent of the federal poverty level, or $15,856 for an individual or $31,322 for a family of four.
Participants in his "Healthy Utah" plan would have to contribute an average of $420 a year toward their health care.
Some would face a work requirement. Low-income parents whose children are on Medicaid could get financial help to move the whole family onto a private health plan.
"On private insurance, they can probably get better quality of care and will have more insurance choices to fit their unique [health] needs," Herbert said. "Nobody's getting a free ride; they've got to put skin in the game. It'll make for a better program with better outcomes and give us better bang for the buck."
Share your opinion
The Department of Workforce Services is seeking public input on its new food stamp work requirements on Wednesday at 10 a.m. in room 157 of the agency's satellite offices (1385 South State Street).