National Children’s Groups Express Concerns About Utah’s Waiver Request

By Joe Touschner

We’ve pointed out the flaws in Utah’s request for a Medicaid waiver in a previous blog post But we wanted to call your attention to them once again since today we submitted a letter to federal officials voicing the concerns of many national groups.

Thanks to all of you who joined us in writing about Utah’s Section 1115 waiver request.  Eighteen national children’s advocacy, provider, and health advocacy groups joined together to voice their concerns to the Obama administration about Utah’s request for the authority to cut children’s benefits and dramatically increase the cost of care for their families.  The group urged Health and Human Services Secretary Kathleen Sebelius to reject the request unless children are appropriately protected.

Utah proposes to waive the requirement that it provide children with EPSDT (Medicaid’s children’s benefits that covers medically necessary care) whenever growth in the state’s per capita Medicaid costs exceeds growth in its general fund spending.  This means children would be on the hook for losing benefits if either state spending grows slowly (as in recessions) or per person Medicaid spending grows quickly, whether that spending is on behalf of children or not (and most of it is not).  EPSDT is a key foundation of Medicaid’s commitment to serving children’s unique needs.   The 18 groups do not believe Utah should be permitted to waive this vital protection that provides care that is medically necessary for kids’ healthy growth and development.

Utah also proposes to waive Medicaid’s cost-sharing protections, potentially exposing very low-income families to unaffordable medical costs in some new and troubling ways. The proposal would give accountable care organizations the authority to set co-payment amounts up to a maximum specified in the proposal and to pick and choose what co-pays to charge to children as “client incentives.”

We do not believe it is appropriate for insurers to decide whether children have to pay more to access needed health services as a result of their (or more likely their parents’) behavior.  Also, research has shown that cost-sharing places a heavier burden on those with low income: they often delay or reduce their use of needed care, leading to poor health outcomes.

Let’s hope the Obama Administration does right by kids served by Utah’s Medicaid program and keeps these important protections in place.