1115 Demonstration Programs and Benefits

Utah’s 1115 Demonstration Waiver has been used to implement the following Utah-specific programs and benefits:

• • Dental
    • Provides state plan dental benefits to all Medicaid-eligible adults age 21 and older.
  • Employer Sponsored Insurance
    • Individuals in the Adult Expansion group are required to enroll in employer sponsored insurance (ESI), if it is available to the eligible individual.
  • Fertility Treatment for Individuals Diagnosed with Cancer: Fertility preservation services are available for beneficiaries undergoing gonadotoxic cancer treatments, or other medically necessary treatment, that is expected to render them permanently infertile.
  • Former Foster Care Youth From Another State
    • Provides state plan Medicaid benefits to former foster care youth from another state up to age 26
  • Health Related Social Needs (HRSN): This demonstration covers the following HRSN housing interventions: housing supports without room and board (i.e., pre-tenancy navigation services, one-time transition and moving costs other than rent, and tenancy and sustaining services), home remediations, home/environmental accessibility modifications, episodic housing interventions with clinical services with room and board (i.e., short-term recuperative care and short-term post-transition housing) limited to a clinically appropriate amount of time, and room and board-only supports (i.e., short term rental assistance) limited to a clinically appropriate amount of time. This demonstration also encompasses Housing Related Services and Supports (HRSS) which provides housing-related services and supports in the form of tenancy support, community transition, and supportive living services to Adult Expansion enrollees experiencing homelessness, food or transportation insecurity, or interpersonal violence and trauma.
  • Intensive Stabilization Services
    • Allows the state to provide intensive stabilization services to Medicaid eligible children and youth under age 21, who are in state custody, or at risk of state custody, and experiencing significant emotional and/or behavioral challenges.
  • In Vitro Fertilization and Genetic Testing for Qualified Conditions:
    Provides in vitro fertilization services and genetic testing for Medicaid eligible individuals who have specific qualified conditions.
  • Justice Involved: Provides limited coverage of targeted services for inmates in a state prison, county jail, or juvenile justice facility for up to 90 days prior to the individual’s expected release date.
  • Medicaid Expansion
  • Residential and Inpatient Treatment for Individuals with Serious Mental Illness (SMI)
    • Provides expenditure authority for services furnished to eligible individuals ages 21 through 64 who receive treatment for a SMI, and who are short-term residents in facilities that meet the definition of an IMD.
  • Substance use disorder (SUD) treatment
  • Targeted Adult Medicaid program
  • Utah Medicaid Integrated Care (UMIC)
  • Utah’s Premium Partnership for Health Insurance