Targeted Adult Medicaid Program
On November 1, 2017, CMS approved the program to provide Medicaid coverage for adults without dependent children earning up to 5% of the federal poverty level (FPL) who are:
- Chronically homeless
- Involved in the justice system through probation, parole, or court ordered treatment needing substance abuse or mental health treatment
- Needing substance abuse treatment or mental health treatment
Approved agencies can provide verification that an applicant is eligible for one of the above eligibility groups. This documentation must be submitted in addition to the standard Medicaid application.
What are the eligibility criteria for adults without dependent children?
All adults without dependent children must meet the following eligibility criteria:
- Age 19-64
- U.S. citizen or qualified alien
- Resident of Utah and not in a public institution
- Household income up to 5% FPL
- Ineligible for any other Medicaid program (with the exception of Medically Needy or Refugee Medicaid)
- Meet one of three targeted categories:
- Group 1: Chronically Homeless
- Meet the definition of continuously homeless for at least 12 months or on at least four separate occasions in the last three years (totaling at least 12 months) AND have a diagnosable substance use disorder, serious mental illness, developmental disability, post-traumatic stress disorder, cognitive impairments or chronic physical illness or disability; OR
- Meet the definition of continuously homeless for a total of six months within a 12-month period AND have a diagnosable substance use disorder, serious mental illness, diagnosable developmental disability, post-traumatic stress disorder, OR
- Currently living in supportive housing and previously met the definition of chronically homeless above, OR
- Who are a victim of domestic violence and living in or residing in a place not meant for human habitation, a safe haven or in an emergency shelter.
- Group 2: Involved in the Justice System and Needing Substance Use or Mental Health Treatment
- Complied with and substantially completed a substance use disorder treatment program while incarcerated, OR
- On probation or parole with a serious mental illness or substance use disorder, OR
- Discharged from the State Hospital after being admitted to the civil unit due to a criminal charge, or to the forensic unit due to a criminal offense, OR
- Court ordered to receive substance use or mental health treatment through a district or tribal court, OR
- Involved with a Drug or Mental Health court.
- Group 3: Needing Substance Use or Mental Health Treatment
- Living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter for 6 months within a 12-month period and has a substance use or mental health disorder; OR
- Receiving General Assistance from the Department of Workforce Services (DWS) and has a diagnosed substance use or mental health disorder; OR
- Discharged from the State Hospital after being civilly committed.
- Group 1: Chronically Homeless
When is enrollment open?
What are the covered benefits?
Targeted Adult Medicaid members receive traditional benefits including the following, with limitations:
- Inpatient hospital
- Including long-term acute care and rehab for intensive skilled care
- Outpatient hospital
- Emergency hospital services
- Clinic services
- Laboratory and x-ray
- Skilled nursing facilities
- Physician services
- Mental health and substance use disorder services
- Including residential treatment of substance use disorders
- Physical and occupational therapy
- Prescribed drugs
- Prosthetic devices
- Women’s services, including family planning (if a member becomes pregnant they will be moved to the Pregnant Woman program)
- Diabetes self-management training
- Tobacco cessation services
- Intermediate care facilities for members with intellectual disabilities
- Medical transportation – both emergency and non-emergency
- Dental – for individuals receiving Substance Use Treatment
If you have questions about your eligibility for Medicaid, please call DWS at 1-866-435-7414.
If you have questions about Medicaid benefits, please call 1-844-238-3091.