Experts discuss the state of post-pandemic healthcare coverage in Utah

By

Maddie McCarthy

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Utah wrapped up its post-pandemic Medicaid redeterminations in April. Net Medicaid enrollment declined by 184,400 since the unwinding began, representing a 35.3 percent drop, according to KFF.

Healthcare coverage experts discussed the outcomes of the unwinding and how it could affect the future of the coverage landscape at the 2024 Utah State of Reform Health Policy Conference in March.

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Laura Summers, director of industry research at the Kem C. Gardner Policy Institute, said publicly-available data detailing the uninsured always lags by about two years, which can make it difficult to assess the current landscape. The most recent data is from 2022.

In 2022, 8.1 percent of Utahns were uninsured. The national average at the time was eight percent. Summers said Utah saw a drastic decline in the rate of uninsured people between 2012 and 2022, though it varied throughout different demographics.

“[There were] really significant declines in our low-income population, as well as those that may be just above the Medicaid eligibility level,” Summers said. “But those [populations] continue to have high uninsured rates as well.”

There are also disparities among different racial and ethnic groups, Summers said. People of color tend to have higher uninsured rates than white people, she said. 

The Affordable Care Act (ACA)—which passed in 2010 but was fully implemented by 2014—Utah’s 2020 Medicaid expansion, and the continuous enrollment that began at the start of the COVID-19 pandemic all affected the state’s uninsured rates between 2012 and 2022, Summers said.

Utah also has a strong economy, Summers said, which has an impact on the high rate of employer-sponsored insurance in the state. 

Matt Slonaker, executive director of the Utah Health Policy Project (UHPP), said the uninsured rate may rise due to the unwinding because the most recent data was collected the year before it began.

“I’m really worried that number is going to go up in the next couple of years despite positive economic trends,” Slonaker said.

UHPP runs Take Care Utah, a program that directly assists consumers with problems relating to healthcare coverage. The program’s “health access assisters” help Utahns find and keep insurance coverage, and educate them on health literacy.

Slonaker said health access assisters helped many people through the redetermination process.

“We’re on the frontlines so we have a lot of anecdotal evidence about what’s going on,” Slonaker said. “We’ve got experience with consumers who have had trouble with redetermination.”

In January 2020, Slonaker said Utah had about 296,000 Medicaid members. In March 2023, before the unwinding began, there were about 530,000 Medicaid members. In January 2024, just before the end of the unwinding, Slonaker said the program covered about 363,000 members. 

It’s important to ensure all those who lost Medicaid coverage between March 2023 and now find it elsewhere, Slonaker said. 

“We have some indication that [people disenrolled from Medicaid] made their way over to the marketplace or in employer-sponsored plans, but we also have indication that they might still be, many of them, uninsured.”

— Slonaker

Slonaker cited survey data from December 2023 that found around 30 percent of Utahns who had lost Medicaid at that point during the unwinding ended up uninsured.

Take Care Utah’s health access assisters have been working to get many of these people on other affordable plans, but Slonaker said the assisters are working at capacity. They have around 40 percent more clients than last year, and around twice as many ACA marketplace clients.

Julie Ewing, compliance director at the University of Utah Health Plans, said the university’s three Medicaid plans lost about 31,000 members during the unwinding. The university also operates marketplace and ACA plans—which is where officials expected those losing Medicaid coverage to go—but there has only been around 3,000 new enrollees under those options. However, Ewing said this could be due to people finding other insurance options, possibly through an employer.

During the unwinding, Ewing said university health plans participated in campaigns and outreach to help beneficiaries. In particular, she said they focused on expanding the number of languages in which people could access information, beyond just English and Spanish. The plans are working on additional projects to ensure members and consumers, in general, are aware of the ways in which the healthcare coverage system works, Ewing said.

“Our community outreach team has been doing member focus groups across all our lines of business for quite some time, and we’re soliciting what we can do better… Across all of our lines of business we see some really basic questions like: How does somebody get insurance? What does it mean when I have it? How do I actually go to a doctor? What other resources are available to me because I have insurance?”

— Ewing

Ewing said she and her team are working on projects to address these questions.

Slonaker said a positive indicator for the coverage landscape is that in 2024, Utah saw its largest number of people enrolling in a marketplace plan during open enrollment. He added that the 2020 expansion will help decrease the rate of uninsured people, as well as the new State Children’s Health Insurance Program (State CHIP), which expanded CHIP coverage to undocumented children.

Furthermore, all states now must provide 12 months of continuous coverage for all Medicaid and CHIP-covered children, Slonaker said. 

“That’s half of our Medicaid program now in continuous eligibility, so that’s great news,” he said.

Ewing said the Utah Department of Workforce Services (DWS), which is responsible for processing Medicaid applications, faced challenges during the unwinding, which made the process more difficult for consumers. Implementing 12-month continuous eligibility across all populations would help lessen the burden on DWS, Ewing said.

“That month-to-month eligibility obviously increases DWS’ workload and makes it harder for our members,” Ewing said.

Summers said figuring out data sharing will be key to understanding the future of the coverage landscape.

“I know there are a lot of federal rules and regulations around data sharing, but the more we can bring up the current data so we’re not always operating on a lag will be key. [And] understanding the data that is publicly available, what it is, what it’s telling us, and maybe what it’s not telling us [will be key].”

— Summers

Going forward, Slonaker said the state should focus on implementing more updated ways of communication, like using texting—as federally allowed—to communicate about address changes and other things that may impact a person’s eligibility determination. He also said the state should improve its ex parte (automatic) renewal system.

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