Utah Adult Expansion Medicaid (AEM): What You Need to Know

Getting coverage

Adult Expansion Medicaid provides health coverage to Utah adults with or without dependent children.

To get coverage, you must meet all of the following rules:

Age: You are at least 19 and up to 64 years old.
Residency: You must meet Utah residency requirements.
Citizenship: You are a U.S. citizen or a qualified non-citizen
Income: Your household income falls below the program’s income limit.
Pregnancy: You are not currently pregnant or eligible for postpartum coverage.

Rules for parents and working adults

Covering your children: If you have children in your home, they must be enrolled in Medicaid, CHIP or another qualified health plan.
Duty of Support: You must cooperate with the state to enforce medical support, unless you qualify for an exception.
Work insurance: If your job offers a qualified health plan (Employer-Sponsored Insurance), you must enroll in it to stay on Medicaid. Medicaid will pay you back for the employee portion of your monthly premium.

H.R. 1 community engagement requirements
(Beginning Jan. 1, 2027)

Beginning Jan. 1, 2027, new federal rules under H.R. 1 will change how adults stay eligible for Adult Expansion Medicaid. These rules require most adults to participate in "community engagement" activities like working, going to school, job training or community service.

This video can help you understand the changes: https://www.youtube.com/watch?v=5nKBac90iYI.

New Applicants: If you apply on or after Jan. 1, 2027, you must meet community engagement requirements to get coverage.
Current Members: If you already have coverage, the new rules will apply when your plan comes up for review (starting with renewals due in March 2027 or later). You can check your renewal date at jobs.utah.gov/mycase.

How to know if the rules apply to you

Use this chart to understand more specifics about who does and does not have to meet the community engagement requirements.

Excluded Individuals

You do NOT have to participate in community engagement activities if you meet any of the criteria below.

Workforce Services will check your eligibility for this exclusion during the month you apply for or renew your Medicaid coverage.

You are excluded if you are:

Medically frail or have special needs including:

Blindness or a disability.
A substance use disorder or mental health condition.
A condition that makes it hard to do daily tasks.

A parent, guardian or caregiver for a child age 13 or younger, or for a person with a disability.

A veteran with a 100% disability.

Subject to work requirements on the SNAP or TANF programs.

American Indian or Alaska Native.

In foster care (or were in the past).

Pregnant or receiving postpartum Medicaid.

Applicable Individuals

These rules apply to you if you are in:

Adult Expansion Medicaid (AEM) or
Targeted Adult Medicaid (TAM)

Workforce Services will check your eligibility for these reasons during the lookback months:

New members — We look at your activities the month before you applied.
Current members — We look at your activities from your last renewal or approval until now.

Exceptions

These are specific situations where you do not have to do the community engagement requirements. These exceptions are grouped into two categories — mandatory and optional short-term hardships.

Mandatory Exceptions

You meet a mandatory exception if you are:

Under age 19.
On Medicare and have Part A or Part B health insurance.
Described in a mandatory eligibility group. These are standard Medicaid groups that the state must cover by law, like low-income parents or individuals getting SSI.
Incarcerated or recently released from jail within the last 90 days.
Specified excluded individuals. This applies if you meet the rules to be in an excluded group during a past month the state is reviewing.

Optional Short-term Hardships

You may qualify for an optional short-term hardship if you are:

Receiving inpatient or institutional care.*
Traveling outside of your community for medical care for yourself or a dependent.*
Living in a county with a federal emergency or disaster declaration.
Living in a county with high local unemployment.

* You must request an exception.

Qualifying Activities

You must show that you are doing one or a combination of these things for 80 hours during each month of your lookback period:

Working a job.
Volunteering or community service.
Going to school (at least half-time).
Earning an income of at least $580/month (or for seasonal workers, an average $580/month income over a six-month period).

How to show you meet the requirement

The Department of Workforce Services will use information we already have to check if you meet the requirements.

If we can verify your work or activities: You do not need to do anything. Workforce Services will send you an approval letter.
If we need more details: Workforce Services will contact you for more information. You may need to submit a form for verification within 30 days, or you could lose your health coverage.

Important: Always check your mail, myCase, email and text messages so you do not miss a notification.

For more information about community engagement, visit obbba.medicaid.utah.gov.