COVID-19 Uninsured Coverage

Effective March 1, 2022, through the end of the public health emergency, the following COVID-19 services or treatments are covered for Utah’s uninsured individuals and should be billed to the Utah Medicaid fee for service program:

  •   COVID-19 Vaccines and Administration:
    • Pfizer-BioNTech
    • Moderna
    • Janssen

For additional information, see the November Interim MIB

  •   COVID-19 Antivirals:
    • Paxlovid (Nirmatrelvir)
    • Molnupiravir
  •   COVID-19 Monoclonal Antibodies:
    • Bamlanivimab injection
    • Etesevimab injection
    • Sotrovimab injection
    • Casirivimab injection
    • Imdevimab injection
    • Bebtelovimab injection

 This coverage is in addition to COVID-19 diagnostic testing and testing-related services which has been covered for uninsured individuals since June 1, 2020.  Covered services include COVID-19 testing, as well as serological tests to determine the presence of the viral antibodies.  Related services covered include the administration of the test and evaluations related to testing, such as x-rays.

Covered testing services also include FDA-approved at-home COVID-19 testing products.  These testing products include those tests where a specimen is collected at home and then sent to a clinical laboratory, or other certified testing site for testing, in addition to those entirely performed at home.  Members can get at-home COVID-19 tests, or home collection test kits, via prescriptions at pharmacies through the Medicaid point-of-sale system.  Members are limited to eight per month.

Uninsured individuals are eligible for the COVID-19 Uninsured Coverage without regard to income or assets. To qualify, an individual must be uninsured, and meet citizenship and Utah residency requirements.  Individuals are considered uninsured if they are not enrolled in another federal health care program, such as Medicare or Veterans Health Administration coverage, or a commercial group or individual health plan.

Individuals may apply online. A representative from the Utah Department of Health (UDOH) will determine eligibility. A decision will be made within two to three business days and the individual will receive notification of the decision. If approved, coverage begins on the first day of the application month.  The individual will receive a Medicaid card within a few days of the approval.

The application also serves as a full Medicaid and/or Children’s Health Insurance Program (CHIP) application, unless the person opts-out. It may take up to 30 days for a decision to be made. If the individual does not qualify for Medicaid or CHIP, the COVID-19 Uninsured Coverage will continue until the last day of the month in which the public health emergency ends. If the individual qualifies for Medicaid or CHIP, the COVID-19 Uninsured Coverage will end but the individual will receive enhanced medical coverage through a regular Medicaid or CHIP program, which includes all medically necessary services.

Additional Resources: