If you are a person with current Medicaid eligibility, available insurance, and a serious medical need, your case may be reviewed for the Buyout Program.
The Buyout Program is a Utah Medicaid program that purchases established health insurance for Medicaid members. Any Medicaid member who has a significant medical need and available insurance that would cover the cost of that need may be referred to the Buyout Program. In order for a member to be enrolled in the Buyout Program, Medicaid Buyout staff must find that enrollment would be cost-effective for the state. Most insurance plans are eligible, including, but not limited to, employer-based group insurance, individual plans, student health plans, etc.
The primary considerations are eligibility for Medicaid, the medical need, the coverage offered under the policy, and the cost-effectiveness of the Buyout purchase. The Buyout Program should not be confused with other programs such as UPP, ARRA, or Buy-in (Medicare Premiums Assistance).
Buyout policy allows for medical coverage only (unless significant need is for dental care). Some examples of significant medical need are:
- Pending surgery
- Acute illness such as AIDS, cancer, transplant candidates
- High pharmaceutical expenses
- Home Health Care
Examples of insurance policies Buyout pays for:
- Employer-based group insurance – Current employment of member, spouse, or parent of a minor (Medicaid reimburses only the portion of those individuals in the family who are eligible for the Buyout Program)
- COBRA (continuation of benefits) after a “qualifying event” (termination from employment, divorce from the policyholder, marriage, or reaching the age of majority of a dependent)
- Student Health Plans
- Individual Health Plans
- Champus – Tricare
If you feel that you may qualify for the Buyout Program, please notify an eligibility worker at the Department of Workforce Services (DWS). If you have a specific question for the Buyout staff, send an e-mail to Buyout@utah.gov. Do not send PHI to this email address. If Utah Medicaid receives a regular, unencrypted email containing protected health information (PHI), there may be some risk that the information in the email could be intercepted and read by a third party during transmission. This may be a reportable incident under the HIPAA Privacy and Security Rules. Please follow your organization’s incident reporting procedure and notify your compliance officer. If you need to send PHI or other sensitive information to us electronically, we strongly encourage you to use a secure method.