On December 23, 2019, the Centers for Medicare and Medicaid Services (CMS) authorized the Utah Department of Health (UDOH) to implement a full Medicaid expansion in the state.  The expansion extends Medicaid eligibility to Utah adults whose annual income is up to 138% of the federal poverty level ($17,608 for an individual or $36,156 for a family of four). The federal government covers 90% of the costs for 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.

The state requires 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.

On August 10, 2021, CMS withdrew approval of Utah’s Community Engagement (CE) requirement. CE required some Adult Expansion members to participate in and report completion of specified work-related activities as a condition of continued Medicaid eligibility. This requirement went into effect January 1, 2020 but was suspended on April 1, 2020 due to the COVID-19 Public Health Emergency. Based on the withdrawal of this amendment, the community engagement requirement has been removed from policy and rulemaking.

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expansion request (known as the “Fallback Plan”), at the direction of Senate Bill 96 (2019 Legislative Session), which superseded previous Medicaid Expansion efforts and replaced Proposition 3 (2018 General Election).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.