Protect Medicaid, Then Make It Better

Why this matters

About 320,000 Utahns get their health care through Medicaid and CHIP. Many are children. Many are seniors in nursing homes and people with disabilities. About 72,000 are low-income working-age adults, covered because Utah voters chose it.

In 2018, Utahns passed Proposition 3 to expand Medicaid, with 53% of the vote. The Legislature scaled it back, then eventually put the full expansion in place in 2020. Utahns decided this one themselves.

Now Washington is taking it apart. The 2025 budget law cut about $911 billion from Medicaid over ten years to help pay for tax cuts that went mostly to the wealthiest Americans. Every member of Utah’s congressional delegation voted for it. Those cuts are the most urgent health care fight in front of Utah right now, so that’s where this plan starts.

320,000Utahns covered by Medicaid and CHIP

$911Bcut from Medicaid nationwide over ten years

33,000–40,000+Utahns expected to lose coverage

Jan. 1, 2027when Utah's new paperwork rules begin

What’s about to happen in Utah

Starting January 1, 2027, adults in Utah’s Medicaid expansion will have to prove 80 hours a month of work, school, training, or volunteering, and do it again every six months. Their eligibility will be checked twice a year instead of once.

Supporters call it a work requirement. In practice, it’s a paperwork requirement. We’ve seen how this goes:

Arkansas tried it in 2018. More than 18,000 people lost coverage in a matter of months, and employment didn’t go up. Advocates there found that most people who were dropped were working or should have been exempt. They just couldn’t get through the paperwork.
Georgia tried it in 2023. More than 90% of the money spent went to running the program, not to anyone’s health care. Researchers found no measurable rise in employment.

The reason is simple: most adults on Medicaid already work. Most of the rest are in school, caring for someone, or too sick to work. The new rules won’t put more Utahns to work. They’ll put more Utahns in the emergency room without coverage.

Estimates of how many Utahns will lose coverage run from about 33,000 to more than 40,000.

The law also squeezes hospitals. It limits the provider taxes and extra payments states use to keep hospitals whole when Medicaid pays less than the cost of care. Utah Medicaid estimates that once the cuts are fully phased in, payments to Utah hospitals will fall by hundreds of millions of dollars a year. Rural hospitals, which depend on Medicaid the most, will feel it first.

Washington works for ideology and dark money. A Utah mother who loses her coverage because a form got lost in the mail isn’t a budget savings. She’s a family in trouble.

Part one: stop the damage

1. Keep the work expectation, end the paperwork trap

I’m fine with asking able-bodied adults without young children to work, train, or volunteer. Most already do. But the state already has the records to prove it.

Check automatically, using wage, tax, and school records the state already has. If the data shows you’re working, you’re done. No forms.
Exempt people automatically when the state already knows they qualify, like parents of young children, pregnant women, caregivers, and people with serious health conditions.
Ask for paperwork only as a last resort, and give people real time and real help to respond.

2. Check eligibility once a year, not every six months

Every extra renewal is another chance for an eligible family to fall through the cracks. Once a year is enough to catch people whose income has changed, and it saves the state money on paperwork.

3. Keep Utah’s hospitals whole

I’d reverse the limits on the provider taxes and hospital payments that help Utah pay its share of Medicaid, starting with protections for rural hospitals. A cut to a hospital in a small town isn’t just a health care cut. It’s a cut to one of the biggest employers in town.

4. Pay for it honestly

Restoring Medicaid costs money, and I’ll be straight about that. The 2025 law took health care from working families to help pay for tax cuts at the top. I’d reverse that trade, starting with the pieces that hurt the most: the paperwork rules, the six-month renewals, and the hospital cuts.

To pay for it, I’d ask the highest earners to pay the same 3.8% Medicare tax on their business income over $400,000 that high-earning workers already pay on their wages. Congressional estimates put that at about $250 billion over ten years.

Part two: make Medicaid better

Protecting Medicaid doesn’t mean leaving it exactly as it is. It’s a 60-year-old program, and it can work better for the families who use it and the taxpayers who fund it.

Source: MACPAC, Medicaid spending by eligibility group, FY 2023 (federal and state funds).

5. A raise should never cost you your health care

Today, a Medicaid family that earns a little more can lose coverage overnight. Too often, people turn down a raise or extra hours to keep their health care. That’s backwards.

Under my plan, anyone can buy into Medicare, with help based on income. When a family earns its way off Medicaid, they’d move straight into the Medicare buy-in with no gap in coverage and a premium they can afford. Work should always pay.

Here’s what that looks like for a Utah family of five:

Family income	Coverage	Yearly premium	Copays
Up to about $52,000	Medicaid	$0	Little or none
About $52,000–$56,000	Medicare buy-in	$0	No
$60,000	Medicare buy-in	about $200	Yes, small and based on income
$75,000	Medicare buy-in	about $1,500	Yes, small and based on income
$90,000	Medicare buy-in	about $3,200	Yes, based on income
$150,000	Medicare buy-in	about $12,700	Yes, based on income

Checkups and preventive care stay free at every income. No cliff, no gap, and every raise leaves a family better off.

6. Focus Medicaid on what only Medicaid can do

Half of Medicaid’s money goes to seniors and people with disabilities. Medicaid pays for more than half of all long-term care in America: nursing homes, in-home care, and the daily help that lets a person with a disability live and work in the community. No private insurance plan covers that, and Medicare mostly doesn’t either.

I’d make sure Medicaid does that job well:

Help people stay at home. In-home care is usually what families want, and it often costs less than a nursing home.
Keep kids covered. Medicaid and CHIP cover nearly 4 in 10 children nationally. Kids shouldn’t lose coverage over a missed form or a small change in a parent’s paycheck.
Take care of moms and babies, before and after birth. A strong start is the most pro-family investment we can make.

7. Go after real fraud, not paperwork

Every dollar lost to fraud is a dollar that doesn’t go to care. I’d go after providers who bill for care they never gave, and fund the investigators who catch them. That’s real fraud. A working mom who missed a deadline isn’t.

What I won’t do

Turn Medicaid into a block grant or cap it in a way that forces Utah to cut care when times get hard.
Let eligible Utahns lose coverage over paperwork.
Cut care for kids, seniors, or people with disabilities to pay for tax breaks.

The bottom line

Utahns voted for Medicaid expansion. Washington is taking it apart to pay for tax cuts at the top. I’d stop that first. Then I’d make Medicaid work better: no paperwork traps, no penalty for earning a raise, and a program focused on the people who need it most.