Adult Expansion Medicaid
Adult Expansion Medicaid covers adults with or without dependent children who are below the 133% Federal Poverty Level after the 5% allowable deduction effective January 1, 2020.
The Community Engagement requirement was implemented in January 2020 but was suspended three months later due to the COVID-19 pandemic. In August 2021, the requirement was withdrawn by CMS. Federal courts ruled that a community engagement (work requirement) is not consistent with the purpose of the Medicaid program, as stated in the Social Security Act. Because the requirement was suspended before it was fully operationalized, there is no impact on Medicaid members. Adult Expansion Medicaid members do not need to register for work and do not need to complete the assessment, training programs, or job searches.
How to Qualify:
- The individual must be a US citizen or qualified alien.
- The individual must meet Utah residency requirements.
- The individual must be between ages of 19-64.
- The individual may not be pregnant.
- The household does not require a dependent child to be eligible.
- If there is a dependent child on Medicaid the adult must cooperate with the Office of Recovery Services for Medical Enforcement or qualify for Good Cause for Non-Cooperation to receive Adult Expansion Medicaid.
- Parents on Adult Expansion Medicaid with children in their home will be required to have those children on Medicaid or CHIP or verify that they have medical insurance that meets Minimal Essential Coverage.
- Working individuals may have an Employer-Sponsored Insurance (ESI) Requirement if they have access to a Qualified Health Plan. They will be required to maintain enrollment to remain eligible for Adult Expansion Medicaid, and will be reimbursed the employee’s portion of the medical insurance premium.
- The household income is below the income limit.
- There is no asset test.
*Both parents or both non-parent caretaker relatives can be included in the medical coverage.