UPDATE, March 26, 10:08 a.m.: Gov. Gary Herbert (R) last week signed legislation expanding coverage of long-acting reversible contraception through Medicaid. 

Two proposals promise new choices under Medicaid to people with low incomes in Utah who lack family planning services or full health-care benefits.

State Rep. Raymond Ward (R-Bountiful) will introduce a bill when the legislative session opens in January to provide contraception coverage to those living below the federal poverty line, which was $12,060 for a childless person in 2017. The legislation would cover birth control pills, long-acting contraceptives, sterilizations, and other family planning services typically covered by Medicaid.

The legislation comes as the group Utah Decides Healthcare mounts a signature-gathering campaign to put the question of Medicaid expansion to Utah voters in November 2018. The initiative needs 113,143 signatures by April to qualify. The campaign says Utah’s uninsured rate of 16.8 percent is nearly double the average uninsured rate of all states.

A similar Medicaid expansion campaign is underway in Idaho. And this month, Maine voters approved a referendum to expand Medicaid over the protests of the state’s Republican governor.

Ward’s legislation would allow those who don’t qualify for Medicaid and perhaps can’t afford to buy health coverage in the Affordable Care Act marketplace to access reliable, long-acting contraceptives.

“When an IUD costs $1,000, it’s just not practical,” said Kyl Myers, a research associate at the University of Utah’s department of obstetrics and gynecology.

If passed, the measure would need a federal waiver, Ward said.

“Let’s say there’s a single woman, and she worked part time or went to school, and only earned $8,000 a year,” Ward, a family physician, told Rewire. “That woman would then be covered by this waiver.”

Estimates suggest 60,000 people in Utah fall in a coverage gap, which studies say lasts an average of 18 months, Ward said. “Many are young, they’re in school, and four or five years from now, they’re going to have a job. Others might have had something go wrong—they’re ill, they’re disabled … and aren’t yet on Medicaid.”

Ward described the bill’s prospects for passage as good in the Republican-held legislature, with one caveat: “The other part is always the harder part—the money.” He said a fiscal analysis of legislation indicates the program would cost the state $600,000 per year, and the federal government $6 million.

“It’s a step in the right direction to ensure families can access family planning services even though they won’t have a full health benefit through Medicaid,” said Matt Slonaker, executive director of the Utah Health Policy Project.

Some 33 states expanded Medicaid under the Affordable Care Act to extend health coverage to people with low incomes.

A recent study in Utah, which has one of the country’s highest usage rates of IUDs and contraceptive implants, found many women with low incomes opted for long-acting birth control that was offered at no cost. Twice as many women left participating clinics with an IUD or implant, compared to six months before the initiative.

“We know that contraception is an incredible tool for preventing unintended pregnancies,” said Myers, project facilitator with the HER Salt Lake Contraceptive Initiative. “So what we’re hoping is that when you’re expanding coverage and reducing cost barriers that women might choose more effective methods.”