Program History


Who Is Eligible?


What Are the Benefits?


Program Requirements


Resources

Program History

On December 23, 2019, the Centers for Medicare and Medicaid Services (CMS) authorized the Utah Department of Health (UDOH) to implement full Medicaid expansion in the state.  The expansion will extend Medicaid eligibility to Utah adults whose annual income is up to 138% of the federal poverty level ($17,236 for an individual or $35,535 for a family of four). The federal government will cover 90% of the costs of these services, with the state covering the remaining 10%.

It is estimated that up to 120,000 Utah adults are eligible for the expansion program. 

Some newly eligible adults will be required to participate in a community engagement requirement in order to receive benefits. Exemptions from the self-sufficiency requirement will be provided for anyone who meets one of 13 exemption criteria, including those who are age 60 or older, pregnant, caring for young children, already working at least 30 hours a week, or students. Those who are subject to the community engagement requirement will need to complete an online job assessment, online training programs, and 48 job searches within the first three months of eligibility. Failure to complete this process will result in termination of benefits. Learn more about the program requirements above.

In addition, the state will require newly eligible adults to enroll in their employer-sponsored health plan if one is available. Medicaid will then cover the individual’s monthly premium and other out-of-pocket expenses like co-pays and deductibles. 

Utah’s waiver request for this expansion included other program components including premiums and surcharges for those over 100% of the federal poverty level, housing supports, and penalties for intentional program violations. CMS is still reviewing these program components and they may be added to the expansion program if CMS approves them at a later date.

Originally, the state was approved to expand coverage to adults earning up to 100% of the federal poverty level (known as the “Bridge Plan”).  This smaller-scale expansion opened enrollment on April 1, 2019 and had a 70% federal/10% state match rate.

UDOH submitted this expansion request (known as the “Fallback Plan”), at the direction of Senate Bill 96 (2019 Legislative Session), which superseded previous Medicaid Expansion efforts and replaced Proposition 3 (2018 General Election). Details regarding SB 96 are available in the Medicaid Expansion: At-A-Glance Chart.

Learn more about the State’s 1115 waiver requests and applications here.