Utah's Eligibility Services Division Helps Successfully Launch Adult Expansion Medicaid



Following the voter-approved Proposition 3 ballot initiative in November 2018 and the subsequent passage of Senate Bill 96 in February 2019, Utah’s Eligibility Services Division immediately began preparations to implement the new Adult Expansion Medicaid program. Eligibility Services leadership worked closely with the Department of Health to ensure the eligibility determination process reflected the correct benefits qualified individuals may receive. This effort required updating the online eligibility determination software to ensure the system accurately processed Adult Expansion Medicaid applications.


To best serve the anticipated increase of new applications for medical benefits, additional staff were hired and all Eligibility Services staff were trained on the Adult Expansion Medicaid program policy and rules leading up to its start date. The Eligibility Services Division’s No.1 goal was to ensure that individuals were able to apply for the new Adult Expansion Medicaid program and receive a timely determination of what benefits they may qualify for when it began on April 1, 2019.


Another significant task leading up to the April 1 start date was the need to convert customers who were participating in other medical programs that would be replaced by the implementation of the Adult Expansion Medicaid program, to the new expanded Medicaid program. During the month of March 2019, Eligibility Services staff reviewed approximately 27,000 medical customer cases for conversion to the new Adult Expansion Medicaid program to avoid loss of coverage for these customers when the former medical programs became obsolete on April 1. With the medical program conversions completed on April 1, there were more than 19,045 customers on the Adult Expansion Medicaid program and 4,488 customers on the Targeted Adult Medicaid program.


On April 1, Workforce Services began accepting new applications for the Adult Expansion Medicaid program. During the first week, there was an approximately 15 percent increase in total volume of new applications, compared to previous months. During the month of April 2019:

  • Eligibility Services received nearly 20,000 new applications (all programs, including medical) that were processed for eligibility determination.
  • 65 percent of the applications received were submitted online (35 percent were submitted using paper applications).
  • There was an approximate 18 percent increase in total volume of new applications, compared to the same time period last year.
  • The average time for eligibility determination was 11 days (annually, the average application process time is 14 days).


At the start of May 2019, there were 23,212 individuals (20,592 cases) enrolled in the Adult Expansion Medicaid program. Additionally, there was a 3 percent increase in total volume of new applications during May 2019, compared to the same time period last year.


The hiring of additional staff and detailed training of all staff leading up to the launch of the Adult Expansion Medicaid program enabled Eligibility Services to avoid any major impacts to the determination process (e.g., backlogs, increased days for a decision, or increased call wait times). The Eligibility Services Division is committed to ensuring individuals continue to receive a timely determination of what benefits they may qualify for.


For more information about the federal and state temporary assistance programs the Eligibility Services Division helps administer, visit: jobs.utah.gov/eligibility.