| Group |
Income Eligibility |
| Children |
200% FPL |
| Pregnant Women |
133% FPL |
| Parents 2 |
42% FPL |
| Adults (Primary Care Network, enrollment capped) |
150% FPL |
| SSI Disabled (non-elderly) |
100% FPL |
Medicaid, SCHIP, and Federal Authority3
Section 1115 Waiver - Utah's Primary Care Network is a statewide section 1115 demonstration to expand Medicaid coverage. The demonstration uses increased flexibility with current state plan eligibles to fund a Medicaid expansion to 25,000 uninsured adults between the ages of 19 - 64 with incomes up to 150 percent FPL. The expansion provides primary care and preventive services to low-income adults who would otherwise lack health insurance. The state's SCHIP program covers children under age 19 with incomes up to 200 percent FPL. The state's premium assistance program called Covered at Work has been replaced with the Utah 's Premium Partnership for Health Insurance (UPP). The UPP program draws federal matching funds under the Primary Care Network waiver.
To learn more about the Utah Primary Care Network, read SCI's Profile in Coverage.
High-Risk Pool
The Utah Comprehensive Health Insurance Pool (HIPUtah) became operational in 1991. The pool is financed by the State Comprehensive Health Insurance Pool Enterprise Fund and legislature appropriations. The premium rate is set at 200 percent of the standard risk rate. As of June 2006, just over 3,300 people were enrolled.
Limited-Benefit Plan
In 2002, the legislature passed HB 122, which permitted insurance carriers to offer coverage that is similar to what is covered under Utah 's 1115 Medicaid waiver ( Utah 's Primary Care Network).
Dependent Coverage
Passed in 1994, Utah requires insurance carriers to provide coverage for unmarried dependents until their 26th birthday. This requirement applies to dependents regardless of their educational status.
Other- Utah's Premium Partnership for Health Insurance (UPP)
In November 2006, Utah announced a revised premium assistance program, the Utah Premium Partnership for Health Insurance (UPP). This program draws federal matching funds under the Primary Care Network waiver and the State's SCHIP Program. Qualified low-income workers and their families can receive up to $150 per adult and $100 per child on a monthly basis to help defray the cost of employer-sponsored insurance premiums if these premiums represent more than 5 percent of their annual income. The program provides funding for up to 1,000 adults with incomes up to 150 percent FPL, and children, whose family income can be up to 200 percent FPL. UPP replaces an earlier program, Covered at Work that offered a monthly premium subsidy of $50.
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