For community-based organizations that assist under- or uninsured people, talking about preventative health care is part of the job, more so given recent changes to Medicaid.
The end of the federal COVID-19 public health emergency in May 2023 included the end of pandemic-era efforts, such as Medicaid expansion to safeguard coverage during the pandemic. Specifically, it means that states have resumed annual Medicaid eligibility reviews.
Known as “Medicaid unwinding,” the process has resulted in at least 17 million people—including low-wage earners, older adults, and people with disabilities—losing coverage, either due to ineligibility or procedural reasons, such as missing or incomplete eligibility information in state databases.
Without health coverage, access to preventative health care that ensures individual and community well-being is diminished, including life saving vaccines, particularly among vulnerable populations. This not only burdens health systems and families but makes public health messaging harder.
Public Good News spoke with Matt Slonaker, executive director of the Utah Health Policy Project, and Take Care Utah team members Daryl Herrschaft and Peyton Thomas about their work to get people in Utah reenrolled in health coverage and what that means for raising awareness about vaccines.
Here’s what they said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
PGN: How does the Utah Health Policy Project connect communities to health care?
Daryl Herrschaft: Through our direct-service program called Take Care Utah, we have about 25 or so health access assisters who are experts in state health insurance and licensed insurance brokers for the [Health Insurance] Marketplace.
We serve communities that are in need, that are underserved. We hold people’s hands from the beginning of the application through the end because it can be so complicated; a lot of people drop off in the process.
Peyton Thomas: Before Take Care Utah was established, there was no statewide effort around reaching underserved communities in Utah to help them access health coverage.
We play a critical role in troubleshooting hurdles that people seeking care may run into, like understanding eligibility criteria, language barriers, complex terminology, communicating with eligibility workers, challenges with verifications.
Then, once somebody’s enrolled in a health insurance program, we’re not just leaving them with these benefits and wishing them good luck. We want to make sure that they understand how to use them and where to use them.
So, we really make sure our “health access assisters” are letting people know that we can help them find providers who accept their coverage where they can access preventative services like immunizations and other care services that will help them and their families stay healthy.
D.H.: We work in a lot of different settings. We work with homeless resource centers. We work with a number of partner organizations in Utah as well as with a criminal justice program where we enroll folks that are leaving incarceration. That’s about half of the enrollment that we do.
We do about 10,000 applications a year. And with those applications we include a message about flu and COVID-19 vaccines in those individual meetings.
PGN: What strategies have worked best for your staff when talking to people about the importance of flu and COVID-19 vaccines?
P.T.: That the message has to be more about overall health and wellness and keeping yourself and your family healthy rather than specifically focusing on the COVID-19 vaccine itself.
Bundling it with other services as part of the insurance coverage element has really seemed to work for us, but also providing it at community health fairs, where they’re also providing vision and hearing screenings.
So, it’s really not just targeting the COVID-19 vaccine itself, which can be controversial, but rather providing an opportunity to access all resources and one safe spot for a community. Really, just focusing on that access element when we’re doing our coverage-to-care process has been helpful.
PGN: How has the Medicaid unwinding impacted the communities you serve in Utah? Can you share more about who you serve?
P.T.: In 2023, more than 40 percent of Take Care Utah’s efforts were directed towards supporting Latinx families and individuals. And more than one in four applications submitted were for a household that listed Spanish as their primary language.
D.H.: Utah is among the states that are on the lower end of getting people to stay enrolled. So, Utah, compared to other states, has lost a huge portion of enrollees.
We did 40 percent more Medicaid applications in 2023 than we did in 2022. Basically, what that means in the work that we do is that we’re coming in touch with more and more people that need our services for health insurance enrollment. So, we’re able to meet them with a message about vaccines as well.
As I was mentioning, a lot of folks may have been disenrolled, not because they’re ineligible but because they failed to submit a document or fill out a form or something that they needed to do.
Matt Slonaker: There are 170,000 folks [in Utah] who are now not on the Medicaid program—but they were in recent months—and we don’t know where they all ended up.
And so [that’s] 170,000 people out of about 3.3 million in the state of Utah—that’s a lot of people.
From the vaccine standpoint, if someone’s uninsured, doesn’t have coverage, and they do get COVID-19, they’re in bad shape. From a financial standpoint as well as a health care standpoint. So, we’re in this place of uncertainty around people being covered.
This article is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the CDC Foundation totaling $69,392,486 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. In addition, the CDC Foundation does not guarantee and is not responsible for the accuracy or reliability of information or content contained in this article. Moreover, the CDC Foundation expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on any information contained within this article. This article are not intended as, and should not be interpreted by you as, constituting or implying the CDC Foundation’s endorsement, sponsorship, or recommendation of the information, products, or services found therein.