Sheriffs, police, mayors rally to save Utah Medicaid program for the homeless, parolees

A wide variety of Utah leaders — including sheriffs, police chiefs and Salt Lake City Mayor Erin Mendenhall — along with advocates for people experiencing homelessness and struggling with addiction or mental health are all rallying to save a Utah Medicaid program from being discontinued. 

Federal officials with the Centers for Medicare & Medicaid Services recently signaled to state officials that they won’t allow Utah to continue its Targeted Adult Medicaid Program, known as TAM. 

Since 2017, Utah’s TAM program has provided 12 months of continuous Medicaid coverage to Utah adults without dependent children earning up to 5% of the federal poverty level who are:

• Chronically homeless.
• Involved in the justice system through probation, parole, or court ordered treatment for substance abuse or mental health.
• Need substance abuse treatment or mental health treatment.

Though state Medicaid officials said in public hearings last week that they may be able to move the program into the state’s current Medicaid expansion programs, advocates and other local leaders remain concerned that the program is in jeopardy and could result in lapsed coverage for vulnerable Utahns because they could lose continuous eligibility. 

The threat to the TAM program — which advocates say is crucial to help reduce jail recidivism, prevent people from returning to homelessness and help people recover from addiction — comes as Utah state leaders have been working to improve Utah’s homeless system with a special focus on people who repeatedly cycle in and out of jails and homeless shelters.

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About 6,500 Utah adults were covered under TAM as of April 2025, according to an overview of the program posted on the state’s website. 

“TAM has saved thousands,” Stephanie Burdick, a co-leader of the Protect Medicaid Utah Coalition, wrote in a document she’s been circulating to stakeholders while urging them to advocate for the program. “But now we must save it from federal bureaucrats that fail to understand our program.”

The issue

Utah’s TAM program was previously approved by federal officials under a federal waiver program known as the 1115 waiver. The state’s waiver is up for renewal, set to expire June 30 next year. 

Though Burdick said state leaders have indicated they’re willing to adjust Utah’s TAM program to comply with a six-month recertification period required by language in HR1, the “big, beautiful” law approved by Congress last year, federal CMS officials have signaled to Utah Medicaid officials that they could take a more restrictive approach and may deny any waiver that has continuous eligibility, even if it’s capped at six months.

“Therefore, Utah has decided to go forward eliminating the TAM program UNLESS they are able to get an indication from CMS that they will approve of 6 months of uninterrupted coverage for TAM,” Burdick wrote. 

So now advocates are urging people to come together to express support of the program to convince CMS to let it stay, she said. Utah Medicaid officials have held multiple public hearings, including two last week, to field comments. The public comment period will stay open until May 21.

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In a May 1 letter to Julie Ewing, Utah’s state Medicaid director, Sarah Aker, the acting director of CMS said the federal authority “does not anticipate” approving or extending section 1115 applications that allow for continuous eligibility — like TAM does — “beyond what is required or available under the Medicaid or CHIP statutes.” CHIP is Utah’s Children’s Health Insurance Program.

“The use of section 1115 demonstration authority to expand continuous eligibility beyond statutory limits raised concerns about Medicaid and CHIP fiscal and program integrity, leading to an increased risk of Medicaid and CHIP payments on behalf of individuals who would otherwise have lost eligibility in the absence of such a section 1115 demonstration,” Aker wrote. “This shift in approach reflects the agency’s commitment to preserving these vital programs for the most vulnerable Americans and being good stewards of taxpayer dollars.”

Aker also wrote that CMS “will continue to work with Utah to support innovative section 1115 demonstrations that promote the objectives of Medicaid and CHIP.” 

Ewing, in a public hearing Thursday, acknowledged concerns about TAM’s future. 

“Since 2017, TAM has provided tremendous value to Utah, and we’re really proud of our program,” she said, noting it was adopted in Utah before the state adopted statewide Medicaid expansion. 

Ewing said it has provided a “critical foundation” for Utahns to “overcome significant life challenges and improve their long-term health outcomes, as well as having the added benefit of actually supporting Utah’s public safety needs.”

“If this were a state decision that we could make, we would continue this program as is,” she said. However, she also said that “while TAM once offered more benefits than adult expansion, that’s no longer the case. The TAM benefits and the adult expansion benefits align. And the main difference … is that TAM offers 12 months of continuous eligibility.” 

Ewing said that under federal law, HR1, Medicaid officials are now required to review adult expansion members every six months instead of every 12 months. 

“The only pathway we have right now to continuous eligibility is through the waiver authority,” she said. “What can be approved in a waiver is entirely at the discretion of CMS at the federal level.” 

Ewing said Utah officials “have made several requests to permit continuous eligibility for TAM,” but CMS has said in the written notice “it will no longer approve or extend continuous eligibility authority under our 1115 demonstration waivers.”

“So the discontinuation of continuous eligibility is not a state decision,” she said. “Because CMS will no longer approve that continuous eligibility, TAM members will transition to the adult expansion Medicaid program effective July 1, 2027. And we do this with a commitment to ensure that people who are eligible for Medicaid remain enrolled in Medicaid.” 

Ewing said “we share” concerns about any Utahns losing Medicaid coverage even if they’re eligible. 

“Getting to this outcome of making sure people maintain Medicaid eligibility will require the support of people in this room, and we hope you will join us in our efforts,” she said. 

Calls to continue TAM

Both the Utah Chiefs of Police Association and the Sheriffs’ Association have sent letters last week to the Utah Department of Health and Human Services urging support of keeping TAM alive. 

“From a public safety perspective, TAM has proven to be an effective and practical tool in addressing some of the most persistent challenges facing law enforcement across our state,” Kane County Sheriff Tracy Glover, president of the Utah Sheriffs’ Association, wrote. 

“A significant majority of TAM participants are justice-involved individuals who often struggle with substance use disorders, mental health conditions, and housing instability,” he added. “These are the same underlying factors that frequently drive repeated law enforcement contacts, incarceration, and crisis situations in our communities.” 

Glover pointed to Sanpete County, where he wrote “the use of TAM to support reentry services for jail inmates has been associated with a reported 61% reduction in recidivism.” 

“Outcomes like this translate directly to fewer repeat offenses, fewer victims, and safer communities,” he said. 

Glover said sheriffs “strongly encourage” Utah officials to pursue a waiver that “preserves the core elements that make TAM effective, including uninterrupted access to care for this high-risk population.” 

Salt Lake City Mayor Erin Mendenhall also spoke during a public hearing Thursday, noting that in 2024 she responded to a call to top state leaders to improve public safety, which among many things included calls to expand county jail capacity. 

“But without stability for someone coming out on the street on the other side of an arrest or a jail stay, we will see no better outcomes and no real improvement on our streets,” she said. “Targeted Adult Medicaid is an absolutely critical component of stability for justice-involved people.” 

Without TAM, Mendenhall said “full implementation” of Salt Lake City’s public safety plan would be “much more difficult if TAM goes away.” 

Advocates and providers of services for the homeless, addiction treatment and others also urged state officials to preserve TAM, especially its continuous eligibility to help vulnerable people continue to have access to coverage and treatment when they need it most. 

A majority of the Salt Lake County Council also issued a letter supporting the program. So did the Weber-Morgan Criminal Justice Coordinating Council, along with former lawmaker and Provo Mayor Marsha Judkins.

Daniel Morris, who spoke during Thursday’s public hearing, called TAM a “beacon of hope for me.” 

“After being in prison for six years and losing everything, reentering society felt scary,” Morris said. “I was worried about many things: my health, mentality and (physical well-being). I knew I needed treatment and therapy, and having such caring people … help me apply for TAM, (I) started to build that hope of succeeding with a second chance.” 

Morris said now, through TAM, he can get that therapy, and “I feel and know with this coverage, I can succeed.” 

“It’s hard to believe and scary to think that TAM could be eliminated,” he said. “It is doing so much good in providing so much help for me and many others. I just ask, please … reconsider what is to be lost with how much there has been gained with the help of TAM.” 

Editor’s note: The key points for this story were written by a Utah News Dispatch journalist.

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