It is with good intentions that federal policy makers are reviewing the status of Medicaid eligibility and guidelines.
Unfortunately, even higher-level policy makers can miss the ripple effects and sometimes even the errors made in proposed policy changes.
This is the case with the proposed reductions in health care coverage for low-income populations, either through Medicaid or Marketplace plans.
Utah began the expansion of Medicaid in 2017. Since then, residential programs serving those with severe mental health and/or addiction disorders have more than tripled their capacity, allowing us to treat those most vulnerable among us, especially those that are cycling through homelessness.
One of the provisions in the “Big Beautiful Bill”, with good intentions, is to require “able bodied adults” to fulfill a work requirement, giving the misperception that those with severe illnesses will be okay.
This is not the case.
Unfortunately, oftentimes, having access to health care is needed to get a person to a place where they CAN work, or to navigate the required systems to ensure the system knows you have complied, or to request and meet the requirements of an exemption.
“Treatment first” examples:
- A low-income person with diabetes. With insulin and medical care first, they can work.
- A homeless person with a severe addiction, anxiety, & PTSD… Unfortunately, these are not qualifying diagnoses for a “disability” (exemption) yet they are in need of aggressive treatment first, before they can function.
- Individuals that are this ill, will NOT have access to the digital or electronic platforms required, or the energy, to justify or convince a Medicaid eligibility specialist that an exception should be made for them. Instead, they need to find the next roof over their head and food, or are just too consumed in “talking to” the voices in their head… Treatment first is needed.
- “…within the criminal justice system, up to 85 percent of adults and as many as 95 percent of women screen positive for a history of brain injury, compared to less than 10 percent of the general population.”[i] They may go undiagnosed, and with their unsteady gait or slurred speech, may lead an officer to assume that substance use has occurred.[ii]
- A study of individuals in a homeless shelter in the Midwest found 71.4% of the participants had experienced a brain injury with loss of consciousness, compared to 8-12% in the general population.[iii]
- 94.1% of the participants experienced their first injury before they experienced homelessness, appearing that this may be a cause of homelessness for some.[iv] These individuals need help first, then hopefully will be able to work in some capacity at a later time.
Many individuals such as these, have undiagnosed disabilities, and would find themselves unable to navigate a work requirement, or the process for an exemption, should the Big Beautiful Bill’s work requirement be put in place. They may appear as “able-bodied individuals”, who could work, but need the assistance of treatment professionals to diagnose them and treat them, with Medicaid as a payor, prior to entering the workforce (if able). Instead, many will drop from care or never receive care.
They will continue to cycle through homeless shelters, jails, and hospitals, at a much higher cost.
For this population, these requirements are “process requirements”, not work requirements, and a challenge they cannot overcome.
Can we reduce Medicaid spending by making it too hard for them to navigate systems? Yes.
But is that how we, as Utahns, want to reduce federal spending?
Instead, we will increase costs to Utah residents through carceral settings, law enforcement and emergency services interventions, homeless services, and through an increase to our own health insurance (as hospitals see an increase in uncompensated care, raising their rates to insurance companies, and passing that on to us).
Do you like to go to the Doctor?
They don’t either.
Giving someone access to healthcare is not like giving someone money that they will then use to buy a 6-pack of beer.
It is a life saving measure, and one that our family, friends, and neighbors may need at some point in time.
Just treat others the way that you would want to be treated.
The Golden Rule.
Jeannie Edens, community member with 25 years of experience helping vulnerable populations.
