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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-312. Adult Expansion Medicaid |
| R414-312-1. Introduction and Authority |
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(1) This rule is authorized by Sections 26-1-5 and 26-18-3 and allowed under Subsection 1115(f) of the Social Security Act. (2) This rule establishes eligibility requirements for enrollment under the Primary Care Network 1115 Demonstration Waiver for Adults, also known as the Adult Expansion Medicaid program. |
| R414-312-2. Definitions |
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The definitions in Rules R414-1 and R414-301 apply to this rule. |
| R414-312-3. General Provisions |
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The provisions in Rule R414-301 apply to all applicants and enrollees. |
| R414-312-4. General Eligibility Requirements |
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Unless otherwise stated, the provisions in Rule R414-302 and Section R414-306-4 apply to all applicants and enrollees. (1) The following individuals are not eligible for Adult Expansion Medicaid: (a) Individuals eligible for any Medicaid program without a spenddown; or (b) Individuals eligible for or receiving Medicare. (2) An individual must be at least 19 years old and not yet 65 years old to enroll in Adult Expansion Medicaid. (a) The month in which an individual turns 19 years old is the first month in which the individual may enroll in Adult Expansion Medicaid. (b) An individual may only enroll in Adult Expansion Medicaid through the month in which the individual turns 65 years old. (3) The eligibility agency may only enroll applicants during an open enrollment period. The Department may limit the number it enrolls and may stop enrollment at any time. (4) The eligibility agency shall waive the open enrollment requirement if the enrollee completes a review within three months of case closure as outlined in Section R414-308-6. (5) A resource test is not required. |
| R414-312-5. Application, Eligibility Reviews, and Improper Medical Assistance |
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The provisions of Rule R414-308 apply to all applicants and enrollees. |
| R414-312-6. Household Composition and Income Provisions |
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(1) The eligibility agency shall use the provisions of Section R414-304-5 to determine household composition and countable income. (2) Section R414-304-12 applies to the budgeting of income through the Modified Adjusted Gross Income (MAGI) methodology. (3) For an individual to be eligible to enroll in Adult Expansion Medicaid, the individual must have countable income at or below 95% of the federal poverty level (FPL). |