Medicaid Expansion

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There has been a lot of talk about Utah's Medicaid Expansion plans in the news recently.  If you currently have Medicaid, nothing changes for you or your coverage.  Utah expanded Medicaid up to the federal poverty level (FPL) and more than 34,000 adults are already receiving coverage since April 1, 2019.  Additionally, anyone who needs healthcare coverage and believes they may be eligible for Medicaid is encouraged to apply for coverage today. 

On April 1, 2019, the Centers for Medicare and Medicaid Services (CMS) authorized the Utah Department of Health (UDOH) to expand its Medicaid program.  This new waiver called the "Bridge Plan" allows the state to expand Medicaid benefits to parents and adults without dependent children earning up to 100% FPL, about $12,492 for an individual or $25,752 for a family of four.

Individuals may submit their applications to the Department of Workforce Services (DWS) to enroll in Medicaid Expansion.  Submitting an application for benefits does not guarantee coverage.  Individuals may also apply in person at a Department of Workforce Services office or by mail.  Call 1-866-435-7414 for an application or with questions.

It is anticipated that approximately 70,000-90,000 individuals will be eligible for this new program, in which the federal government will cover approximately 70% of the costs and the state will cover the remaining 30%.  Approximately 40,000 individuals from 101-138% FPL will continue to receive services through the federal Marketplace.

On July 31,2019, the State also submitted a new 1115 Waiver application to CMS called the "Per Capita Cap Plan."  This plan is intended to replace the "Bridge Plan" but must receive CMS approval before implemented. The "Per Capita Plan" covers adults up to 100% FPL and requests the following provisions: self-sufficiency requirement, enrollment cap, up to 12-month continuous eligibility, employer-sponsored insurance enrollment, lock-out for intentional program violation provision, and a per capita cap.  This plan also requests 90% federal/10% state funding.  

In addition to submitting the "Per Capita Cap" waiver application, the State is also working on the "Fallback" waiver, which raises eligibility to 138% FPL at the 90/10 federal/state match rate. The "Fallback" waiver includes some of the same elements as the "Per Capita Cap" waiver, with the primary exception of the per capita cap itself. Senate Bill 96 requires the "Fallback" waiver be submitted by March 15, 2020. The State is working to expedite that timeline.

These plans are being implemented as directed by Senate Bill 96 (2019 Legislative Session).  This bill supersedes previous Medicaid Expansion efforts and replaced Proposition 3 (2018 General Election).  Details regarding both plans and SB 96 are available in the Medicaid Expansion: At-A-Glance Chart below.  

More information about Utah’s Medicaid Expansion efforts:

Expansion Flyer: English Spanish

Expansion Poster: English Spanish

Expansion FAQs

Expansion At-A-Glance Chart

Governor Herbert's Medicaid Expansion: What's Next for Utah?

Contact Information:

If you have questions about eligibility or to apply, call DWS:  1-866-435-7414

If you have questions about Medicaid benefits or providers, call a Medicaid HPR: 1-866-608-9422

If you are a provider and have questions about claims or patient eligibility, call the Medicaid Hotline: 1-800-662-9651

If you are a member of the media, call 801-538-6847.

You may also email questions to: medicaid-expansion@utah.gov