SALT LAKE CITY — Late last month, the Centers for Medicare and Medicaid Services approved Utah’s waiver to expand Medicaid coverage to individuals living at 138% of the federal poverty rate. Those seeking Medicaid under the expansion were able to begin the enrollment process Wednesday.

Utah Department of Health officials said they believed the expansion would make 120,000 new Utah adults available for the program. So, what is it and why does it matter? spoke with Kolbi Young, the department’s Medicaid spokeswoman, who helped explain the program and the changes.

First off, it’s important to remember that Medicaid and Medicare aren’t the same things. Medicare is the federally-funded insurance program for people who are 65 or older, as well as people with certain disabilities and illnesses.

So, what is Medicaid? The Social Security Administration defines it as “a jointly funded, federal-state health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.”

Young said people must meet income and eligibility requirements before they are enrolled.

There were 287,382 people enrolled in Medicaid as of November 2019, according to Young. That was just before the waiver to extend Medicaid was approved.

Of those, more than half — some 165,000 — were children. There were also 67,000 adults; 34,000 people with disabilities; 16,500 persons above 65; and 4,000 pregnant women enrolled, Young said.

A plan to expand Medicaid coverage first passed through an initiative in the 2018 election. It sought to expand coverage to 138% of the federal poverty rate. Some of the initiative was later altered under SB96 in 2019. Under the bill, the state asked for the federal government to pay for 90% of the expansion. Utah’s initial federal waiver requests were rejected, but a “Fallback Plan” was finally accepted on Dec. 23.

It means the poverty threshold is different in 2020. Now, an individual adult whose annual income is lower than $17,236 or a family of four with an annual income under $35,535 can qualify for Medicaid.

“It depends on income and then the category of eligibility,” Young said. “There are different groups of people who are eligible — elderly individuals, children, pregnant women; and then within that eligibility category, there are eligibility requirements.”

That includes a self-sufficiency or work requirement. According to the state’s website, there are 13 exemption criteria for the self-sufficiency requirement after the expansion, which include “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.”

Young said people can sign up for Medicaid in multiple ways. They can go online at the state’s Medicaid website and apply.

People can also print out an application, fill it out, and mail it to the Department of Workforce Services, P.O. Box 143245, Salt Lake City, UT 84114-3245. The other way is to visit a Department of Workforce Services location and fill out an application there. A full list of locations can be found here.

After an application is submitted, the case is reviewed by a Department of Workforce Services employee.

“(They) will look at all the programs available and see what the individual or that family qualifies for,” Young said.

The department has 30 days to review the application and make a determination, she added.

Anyone who has further questions about Medicaid enrollment is encouraged to call the Department of Workforce Services at 801-526-0950 or at 1-866-435-7414. People can also receive free enrollment assistance from Take Care Utah, a nonprofit healthcare initiative group, by visiting its website or by calling 2-1-1 or 801-433-2299.


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