Utah to Implement Full Medicaid Expansion

Media Contact:

Tom Hudachko

Utah Department of Health

801.560.4649

Utah to Implement Full Medicaid Expansion

(Salt Lake City, UT) – The Utah Department of Health (UDOH) today received approval from the Centers for Medicare and Medicaid Services (CMS) 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 ($16,753 for an individual or $34,638 for a family of four). The federal government will cover 90% of the costs of these services, with the state covering the remaining 10%.

Enrollment and coverage for the newly eligible individuals will begin on January 1.

Today’s announcement, along with a smaller-scale expansion implemented last April, means up to 120,000 Utah adults who didn’t qualify for Medicaid at the beginning of 2019 qualify today.

“CMS’s decision is evidence states can craft viable, unique solutions to deliver critical health care services to their residents,” said Utah Governor Gary R. Herbert. “I want to thank CMS Administrator Seema Verma, along with her dedicated staff, who worked quickly and diligently to approve this request and allow us to expand within the parameters set by our state law.”

“Under Governor Herbert’s exemplary leadership, his state diligently pursued innovative and sustainable solutions to improve the lives of all Utahns,” said CMS Administrator Seema Verma. “Local leaders understand how to best design programs that align with their local needs and goals, and I am committed to helping states achieve their goals. I thank the Governor for his strong commitment to delivering impactful results to his state, and look forward to our continued work with Utah as we consider further enhancements to their health care programs.”

Some newly eligible adults will be required to participate in a self-sufficiency 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 self-sufficiency 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. 

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. 

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.

UDOH submitted this expansion request (known as the “Fallback Plan”), at the direction of Senate Bill 96, which was sponsored by Sen. Allen Christen and Rep. Jim Dunnigan. “Over the last couple of years, we have explored and implemented several expansion options,” said Rep. Dunnigan. “This approval is very important for our state budget so we can begin receiving the higher federal match for these services. We look forward to working with CMS to obtain approval of the remaining components of our request so this expansion has the additional supports and cost controls we envisioned.”  

To be eligible for the new program, individuals must be a Utah resident between the ages of 19 and 64, be a U.S. citizen or legal resident, and meet income requirements. Information on how to apply for Medicaid can be found at https://medicaid.utah.gov/apply-medicaid. Applications are accepted online, over the phone, or by mail. 

# # #