The Utah Reauthorization Project (UREAP) seeks common ground recommendations for the next phase of welfare reform. UREAP is described in the final pages of this Position Paper, including its goals, principles, and membership.

We begin by expressing appreciation for bipartisan Congressional support for providing health insurance for many low-income working families. Health care insurance is a critical support for working families and working poor people. Health care insurance is also essential for people with disabilities returning to or entering the workforce. Economic downturns put tremendous fiscal pressures on states to cut public health care programs. During its 2002 General Session, the Utah Legislature reduced Medicaid and CHIP services in response to revenue shortfalls. Numerous families lost Medicaid coverage unnecessarily as welfare reform has been implemented. Federal regulations restrict eligibility unnecessarily. We urge Congress to address these issues in its welfare reform reauthorization deliberations, as well as to reauthorize Transitional Medical Assistance (TMA) and continue its bipartisan support for Medicaid as a work support.

Restructuring Medicaid and States Child Health Insurance Programs

While fine tuning Medicaid and other health programs based on what we've learned since 1996 is desirable, UREAP does not recommend a major, wholesale restructuring of these programs as part of welfare reform reauthorization. Health care reform should be taken up at some future time on its own merits and not rushed along with reauthorization of related programs.

Increasing Coverage

1.    Reauthorize and amend the law to allow states to provide Transitional Medical Assistance (TMA) for a full year, without recertification requirements.
2.    Drop the Medicaid three of six months eligibility rule so families that find employment quickly or are diverted from cash assistance can access TMA if necessary.
3.    Allow states the option of dropping TMA if they elect to offer family-based coverage up to 185% of the poverty line.
4.    Continue mitigation efforts in the states to restore Medicaid eligibility to families who lost eligibility due to error or misunderstanding.
5.    Create and fund a new program to cover parents up to 200% of the poverty level, avoid waiting lists or closed enrollment periods, offer 12 months of continuous eligibility, and conform Medicaid and SCHIP application forms and processes.
6.    Expand SCHIP outreach to bring in more low-income eligible children, and amend the law to include eligible children of low-income public employees, and raise the 10 percent cap on administrative expenditures and outreach to allow for more effective outreach, or fund outreach separately and adequately.
7.    Modify federal law (Medicaid and SCHIP) to allow states to use the same tools to facilitate children's health insurance enrollment for family-based coverage, such as the option to guarantee twelve months of continuous coverage and to use health care providers and organizations that work with low-income working families.
8.    Allow states flexibility to serve noncustodial parents who meet their child support obligations.
9.    Give states greater financial incentives to extend eligibility for health insurance to more low-income working parents and increased flexibility to simplify various procedures in order to facilitate the enrollment of more eligible families. For example, specific attention should be addressed to low-income child care workers without health insurance; they perform valuable socially-desired work in caring for children and deserve society's support.
10.   Give states flexibility and incentives to cover legal immigrants.
11.   Provide funding to enable states to cover the parents of children enrolled in SCHIP and Medicaid programs.

Expanding Collaboration and Coordination among Programs and Services

1.    Enhance Medicaid and Medicare collaboration to address policy and operational issues that impede effective coordination of these two important programs.
2.    Coordinate Medicare and Medicaid services by supporting state waiver proposals to integrate care for persons eligible for both. In computing the "budget neutrality" of such state waiver proposals, the federal government should recognize the potential of cost savings not only for Medicaid, but also for Medicare, SSI, and SSDI.
3.    Facilitate eligibility coordination across programs and promote continuity of care by reviewing eligibility categories and collapsing the multiple mandatory categories into fewer, more readily understood groupings.
4.    Medicaid and State Children's Health Insurance Program (SCHIP) statutes should permit blending of public and private insurance coverage and continuity of care.
5.    State proposals to subsidize private health insurance premiums for low-wage workers should be encouraged.
6.    Programs to facilitate exchange and retrieval of medical information, while safeguarding confidentiality, should be encouraged.
7.    Support the development of partnerships to reduce health disparities among racial and ethnic population groups.

Addressing the Americans with Disabilities Act

1.    Support state efforts to comply with the Americans with Disabilities Act and their efforts to develop appropriate alternatives to institutional care on implementation timetables that allow for sound management, affordability, and quality.
2.    Continue to support the Medicaid infrastructure and benefits for people with disabilities begun in the Ticket To Work Act.
3.    Encourage federal housing programs to partner with Medicaid to assist elderly persons and individuals with disabilities to live in their communities rather than institutions.
4.    Encourage the development of models of federal and state partnerships that address the workforce shortage in long term care.

Prescription Drug Program

1.    Examine prescription drug issues to update OBRA '90 rules, alter the rebate formula, and allow state flexibility to set copayments in a manner that will encourage consumer price awareness.
2.    Fully federally fund a new program that would assist senior and disabled individuals, particularly low-income individuals, to meet the steadily rising cost of prescription drugs. This acknowledges that rising drug costs are a national problem requiring a national solution.
3. Any new federal prescription drug assistance program must have a cost containment element. Generic drug substitutions are appropriate in medically approved situations.

Funding

1.    Commit federal dollars to design streamlined Medicaid eligibility and operating systems.
2.    Fund costs for additional coverage at the SCHIP rate, a more favorable rate to states than the Medicaid matching rate.
3.    Provide states funds for planning and demonstrations on covering uninsured groups.
4.    Expand states' flexibility and enhance federal funding toward the goal of covering more uninsured people using Medicaid and SCHIP programs.

State Flexibility

1.    Federal policy should recognize states' power as purchasers in the marketplace of health care and avoid micro management.
2.    Provide states adequate flexibility within Medicaid to offer targeted benefits and appropriate cost-sharing to uninsured or underinsured adults, as long as no medically necessary established service is eliminated or currently eligible person is denied present benefits.
3.    Allow states to convert waivers into State Plan status after evaluations ensure positive outcomes.

Utah has a long history of considering how to help welfare families become self-reliant. The Utah Reauthorization Project (UREAP) is a broad-based effort to educate state and national decision-makers and the public about needed refinements to the current welfare system, to muster congressional support for common ground solutions that will help stabilize vulnerable families, and to enhance efforts to address poverty in our state and nation.

UREAP has as its vision of the next phase of welfare reform strengthening our nation by building families' and individuals' economic and social well-being. We seek to be involved in realizing this vision as Congress considers the 2002 Reauthorization of major pieces of the 1996 welfare law, as well as related measures in the intervening months and beyond.

UREAP will support and encourage provisions which:

1. set a clear and consistent goal to reduce poverty.
2. meet temporary and emergency needs.
3. facilitate job advancement and increased earnings through training or skill-development for those who can move toward self-reliance.
4. sustain basic needs and dignity for those families and individuals who are not able to achieve self-reliance.
5. afford families and individuals with the opportunities and resources they need to address their barriers to achieving economic independence before they leave the welfare system.
6. support the efforts of families and individuals to move forward.
7. make work pay.
8. provide necessary supports to families and individuals as they transition from welfare to work.
9. emphasize the care and well-being of children, as they are the majority of welfare recipients.
10. include appropriate flexibility and encouragement to allow states, localities, and Indian Tribes to run programs that are responsive to special populations and circumstances.
11. provide increased or at least present levels of funding to support necessary programs and services to effect positive outcomes for families and individuals.
12. finance welfare reform without resulting in harm to other vulnerable groups.

Active Re-Entry, Price, (Southeastern Utah)
Box Elder Family Support Center, Brigham City, (Box Elder County)
Bringing Hope to Single Moms Foundation, Logan, (Cache and Box Elder Counties)
Community Action Services, Provo, (Utah, Wasatch, and Summit Counties)
Disabled Rights Action Coalition (DRAC), Salt Lake City, (statewide)
Family Support and Children's Justice Center of Carbon and Emery Counties, Price
International Rescue Committee, Salt Lake City, (statewide)
JEDI for Women, Salt Lake City, (statewide)
Legislative Coalition for People with Disabilities, Salt Lake City, (statewide)
Mental Health Association in Utah, Salt Lake City, (statewide)
New Hope Refugee and Multicultural Center, Salt Lake City, (Salt Lake City)
Options for Independence, Logan, (Northern Utah)
Peace and Justice Commission, Catholic Diocese of Salt Lake, Salt Lake City, (statewide)
People Helping People, Salt Lake City, (Salt Lake County)
Salt Lake Community Action Program (SLCAP), Salt Lake City, (Salt Lake and Tooele Counties)
Tri-County Independent Living Center, Ogden, (Weber, Davis, and Morgan Counties)
United Way Executive Directors Association (UWEDA), Salt Lake City, (Salt Lake County)
Utah Children, Salt Lake City, (statewide)
Utah Community Action Program Association (UCAPA), (statewide)
Utah Issues, Salt Lake City, (statewide)
Utahns Against Hunger, Salt Lake City, (statewide)
Valley Mental Health, Salt Lake City, (Salt Lake and Tooele Counties)
Walsh & Weathers Research and Policy Studies, Fruitland
Your Community Connection, Ogden, (Weber County)

Membership as of March 4, 2002

The URL for this position paper is www.slcap.org/UREAP/UREAPMedicaidPosPaper.html. For more information on the Utah Reauthorization Project (UREAP), please go to www.slcap.org/UREAP/ureap.htm or contact Shirley Weathers and Bill Walsh, Walsh & Weathers Research and Policy Studies, P. O. Box 270090, Fruitland, UT 84027-0090, (435) 548-2630, FAX (435) 548-2438, email wrw@ubtanet.com.