This story is part of The Salt Lake Tribune’s ongoing commitment to identify solutions to Utah’s biggest challenges through the work of the Innovation Lab.

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Utah’s Medicaid population is a smaller proportion of the population than nearly every other state, according to data from multiple sources.

Advocates say the state’s strong economy and low unemployment rate likely keep enrollment low compared to other states but barriers like a complicated application also are factors.

That isn’t Utah’s vision for residents who are eligible for Medicaid, countered Jennifer Strohecker, the state’s Medicaid director.

The state “absolutely” is trying to remove barriers and obstacles and wants to use member feedback to do so, she said.

Low enrollment rate compared to other states

Utah has the lowest or among the lowest proportions of its residents on Medicaid, depending on the data source:

• U.S. Census Bureau: 11.3% enrolled in 2021, the lowest percentage of any state and more than nine percentage points below the average of 20.5%.

• KFF: 11% enrolled in 2021, lower than every state but North Dakota.

The data likely is out of whack because of the coronavirus pandemic, said Matt Slonaker, the executive director of the Utah Health Policy Project.

There probably won’t be a clear picture of where the state stands until next year, Slonaker said, but he thinks Utah will probably “still be in the lower ranks.”

Application is ‘really difficult’ to fill out

Utah’s flourishing economy is likely part of why available data shows the rate is lower because people don’t need to lean on Medicaid as much, Slonaker said.

But he and others said Utah doesn’t do enough outreach or give enough applicants adequate help, and there is a stigma around receiving social services.

Applicants often struggle to fill out 23 pages that require a lot of repeat information, said Carrie Butler, executive director of the Utah Public Health Association. That’s especially true if English isn’t their first language or they have a lower capability to process language, she said.

Utah generally isn’t great at advertising Medicaid, Slonaker said.

Daryl Herrschaft, who manages the policy project’s program Take Care Utah, described Medicaid programs as “kind of like our state’s best-kept secret when it comes to letting people know it’s available.”

‘Almost a taboo’ about enrollment increases

Advocates also point to state culture as a factor impacting Medicaid enrollment.

Slonaker has seen a pivot in the last decade to lawmakers “accepting some programs as a vehicle forevermore to make sure underserved, low-income folks have access” to health care. Generally, though, he thinks there is a stigma around Medicaid.

Butler described legislators getting concerned when enrollment numbers go up like there is “almost a taboo” about it.

Ciriac Alvarez Valle, a health policy analyst with the nonprofit Voices for Utah Children, said there are “worries about being on Medicaid and just like social services in general” because of the stigma and, sometimes, because of misinformation about the impact on immigration status.

And Butler said there is a “deep misunderstanding” about health insurance risk pools and that culture wars impact how Utah is able to serve its most vulnerable citizens.

State looking at Medicaid program improvements

Strohecker pushed back against the critical narratives and said it is the state’s goal to make sure everyone enrolled in Medicaid has access to high-quality care.

She is passionate about serving the Medicaid population and addressing barriers they face in accessing coverage and care.

Utah DHHS already knows about issues with procedural closures and long wait times for customer service, she said, partially because the Centers for Medicare and Medicaid Services has called those out during the unwinding.

Strohecker said the state is working to automate a process using available data to confirm eligibility and renew coverage instead of sending out renewal documents and requiring members to respond.

Utah also may use automation to improve the application, she said, and the state is looking at other possible improvements to that process, including quick-tip videos based on common issues.

Need help?

Medicaid members with questions about unwinding can go to medicaid.utah.gov/unwinding/ and can check their individual status at jobs.utah.gov/mycase.

An article with advice on remaining enrolled in Medicaid can be found here.

The Utah Health Policy Project’s Take Care Utah program also provides help for those navigating the system.