Advocates say underserved Utahns don’t know they can sign up for expanded Medicaid

Brittany Roylance, who signed up for Medicaid under this year’s partial expansion, speaks about how the ability to receive health care has benefited her life on Tuesday, Oct. 1, 2019, in West Valley City. | Ashley Imlay, Deseret News

Six months into expansion, enrollment numbers are far below expected levels

WEST VALLEY CITY — Earlier this year, Brittany Roylance had been living on and off Salt Lake City’s streets for several months.

Dealing with addiction, Roylance says she voluntarily gave up her four children so they could have a better life.

But now, the Utah mom says she looks forward to a day when she can be in her kids’ lives again after receiving mental health and medical treatment. That happened when an advocate helped her sign up for Medicaid under the state’s partial expansion, she said.

“I feel that there are a lot of people like me that are slipping through the cracks that don’t know what resources there are out there, that don’t know how to get help, or are really lost, misled, misguided, misunderstood people like myself who have been homeless and without,” Roylance explained Tuesday as she and members of Utah Health Policy Project’s Take Care Utah, which helps people enroll, gathered to celebrate six months of expanded Medicaid.

While there have been some successes and more families have gained coverage, advocates said far less than expected have benefited from the program.

Six months in, 37,000 people have signed up, while nearly twice that number had been estimated to enroll by the end of the year, the group said. And most of those enrolled were simply transferred from other programs.

“It was a surprise. And so these months have taught us that ... we’ve learned that there’s just a lack of resources, there’s just misunderstanding. What we found as we’re helping individuals is the confusion. It’s like, ‘I’ve been denied in the past, and now you tell me I qualify, right?’” explained Luis Rios, a program director with Take Care Utah.

“And that’s just what it is, right? For an individual, if their income is below about $1,000 a month, now they qualify for Medicaid. Which, in the past, they wouldn’t. And so it’s just kind of like that mindset has just got to shift, and it’s going to take time.”

Roylance said that when she met someone with Take Care Utah, she had “little understanding of what any of my resources could have been.”

While she hopes to be reunited with her children, three of whom are with family members and one who is in an open adoption, “for right now, I need to take care of myself. And the first thing in doing that was being able to get Medicaid expansion.”

Alicia Martinez, CEO for Midtown Community Health Center, said, “Medicaid expansion has made a world of a difference, and for us, while we still have a lot of work to do, we’ve already seen the difference in just connecting services.”

For many, getting enrolled can mean “the difference between having options for what doctors you can see, to the medications that you need and vital procedures that individuals need,” Martinez said.

“But we need the voices to continue to spread the word for coverage, because this is available to so many individuals that yet don’t understand that they might be eligible.”

Maria Guadarrama, also with Take Care Utah, said that some factors causing low enrollment numbers might be “the legislative changes in the initiative have been confusing to many of us — also, of course, to the public.”

“Additionally, the process of getting and keeping Medicaid is also very complicated. Almost every application requires additional documentation and follow-up work, and for some of our clients, not having access to reliable internet or computer access also creates barriers to obtaining coverage,” Guadarrama explained.

Language barriers, lack of access to media, transportation and geography, time constraints, and health care literacy also get in the way of many enrolling, she said.

But she wanted to let people know “assisters” at Take Care Utah are available to provide free help. More information can be found at takecareutah.org.

“Medicaid expansion will provide more benefits to our communities if we keep increasing that enrollment. Our goal is to connect people to coverage to help build a healthier Utah,” Guadarrama said. “Even if you think that you don’t qualify, we will do a screening process, let you know what options are available for you.”

On Friday, the state posted its “fallback” expansion waiver for public comment, which would increase eligibility to those making between 100% and 138% of the federal poverty level — with a self-sufficiency requirement, and enrollment in an employer’s plan with premium reimbursement when offered.

According to expansion bill SB96 — passed as an alternative to full expansion called for by voters under Proposition 3 — the state has to work through a couple of options before Medicaid would be fully expanded. If those proposals are not approved by U.S. Centers for Medicare and Medicaid Services by July 1, 2020, the health department must then institute full expansion in Utah, increasing eligibility to those making between 100% and 138% of the federal poverty level under the Affordable Care Act.

Utah has been in a holding pattern since it received an informal rejection from the federal government on waivers under its limited plan that covers adults up to 100% of the federal poverty level with a self-sufficiency requirement and per-capita cap.

Matt Slonaker, Utah Health Policy Project executive director, said that he and the group’s policy analyst, Stacy Stanford, talked to the governor’s policy director on Tuesday. They had planned to urge the governor to submit a state plan amendment fully expanding Medicaid under the Affordable Care Act, an act legislators had said couldn’t legally happen.

But now that the state proposed its “fallback” waiver, the group is waiting to see whether the Trump Administration will approve it, Slonaker said.

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