Until April 2, Utah was the last state standing with a work reporting requirement in place. It took a pandemic coupled with an economic crisis for the state to finally suspend its onerous paperwork barrier to Medicaid coverage.
After federal courts overturned work requirements in states like Arkansas and Kentucky, which pushed other states like Arizona and Illinois to reverse the policy, Utah remained stubbornly committed to the idea that its “work effort” was different. Rather than requiring a certain number of employment hours, Utah’s rule required non-exempt enrollees to fill out 48 job applications in a three-month period. State officials argued that requiring an effort to get work was less burdensome than actually requiring employment. Of course, this angle completely misses the point of advocates’ concerns about paperwork barriers. The Utah “work effort” mandated a mountain of paperwork, from online screenings and trainings, to dozens of job applications, to reporting back to the state on each of those applications. In the face of COVID-19, the argument that Utah’s requirement was less burdensome was especially absurd. We began asking questions about how enrollees access internet when libraries are closed, or how they find jobs to apply for when businesses across the state are largely shut down. The hurdles in the work requirement were brightly illuminated under the spotlight of the coronavirus.
While it may have taken a global catastrophe for Utah to finally act, it wasn’t without immense pressure from advocates along the way. From the beginning of our fight against the repeal of the Utah Decides Healthcare ballot initiative to fully expand Medicaid, advocates have been sounding the alarm about the danger of “community engagement” work requirements.
As state leaders proudly announced their “bridge plan” to partially expand Medicaid last year, we held a press conference at a popular Salt Lake City park, in front of a beautiful, sturdy bridge, where we walked reporters through the four secondary coverage gaps, or “missing planks,” in the state’s new plan. We called out the danger of work requirements, and discussed how people would face complicated barriers, fall through the cracks, and be left without care. We spent a year continuing to share the broken bridge message through an earned media campaign – reaching out to reporters, appearing on podcasts, writing op-eds and letters to the editor, and collecting and sharing thousands of public comments.
This advocacy effort included outreach to legislators, the Governor, and other decision makers. As the COVID-19 crisis emerged, we turned up the volume, asking questions and applying pressure in every opportunity possible. Our organization, and several of our partners, drafted lists of policy recommendations—with suspension of work reporting requirements at the top of the list. These were sent to Department of Health officials and the Governor’s office. After weeks of advocacy, the state confirmed that they would suspend the work requirement, and all involuntary disenrollment.
Medicaid is an essential part of the safety net that protects our neighbors in times of crisis. The financial and health care protections of Medicaid expansion will lessen the catastrophic effect of COVID-19 for low-income Utahns. States should be making every effort to roll out the welcome mat to Medicaid, rather than maintaining barriers to care. We are so grateful for the diligent work of health care advocates that got us to this place, where Utah is a state with full Medicaid expansion, no strings attached, finally.
The growing economic and public health emergency only reinforced the clarity of our message: Medicaid matters. Penalizing lack of employment by taking away health care is cruel, ineffective, and hinders Medicaid’s ability to support our communities –especially during emergencies.
Stacy Stanford, Health Policy Analyst, and Courtney Bullard, Education and Collaborations Director, Utah Health Policy Project