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Utah Medicaid Eligibility Rules

Public health insurance programs like Medicare and Medicaid can be complicated for new users. Adding to the confusion is the patchwork set of rules that vary by state with the Medicaid program. These differences are because of the federal/state partnership that runs Medicaid, unlike Medicare which is funded and administered exclusively at the federal level. Utah's eligibility rules are similar to neighboring states, but they include a proof-of-citizenship requirement.

  1. Agency in Charge

    • Since 2008, the Department of Workforce Services has administered applications for Medicaid. As of January 2011, Workforce Services employs 980 case managers who not only process applications for Medicaid but for food stamps and other federally funded programs as well. It took over the responsibility from the Utah Department of Health in 2008.

    Citizenship and Residence

    • All Medicaid recipients in Utah must be U.S. citizens or qualifying aliens, according to the Utah Department of Health. Applicants must provide documentation proving U.S. citizenship or qualified status that may include a birth certificate, U.S. passport or certificate of nationalization. Applicants must also be residents of the state, but there is no minimum duration required. Applicants must only express intent to stay in Utah, whether or not they have a current physical address or place of employment. Applicants may not simultaneously receive aid from another state.

    Income

    • Income limits depend on the size of the household, the current Federal Poverty Level, or FPL, and the Basic Maintenance Standard, or BMS. Income is defined as cash or in-kind benefits a person receives each month. In-kind benefits count toward the income total only if they are food or shelter or they can be used to get food or shelter such as food stamps or housing vouchers. As of 2010, the FPL for an individual is a net $903 per month. Eligible income levels in Utah must be less than or equal to 100 percent of the FPL. Income above that level could still qualify applicants for different assistance programs.

    Eligibility Period

    • Qualified applicants are approved to receive benefits for a period of up to 12 months, although administrators may assign a shorter eligibility period to applicants whose circumstances are likely to change within that time. Periods as short as three months are possible in some cases. The last month of eligibility is termed the "review period," and during this time, those receiving benefits must prove they are still eligible for the benefits they receive.

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