Aged, Blind or Disabled Persons, Medicaid in Utah

The Aged, Blind or Disabled Programs are medical assistance programs for individuals aged 65 years or older, blind or disabled.  Persons who receive SSI (Supplemental Security Income) or Social Security Disability benefits meet the conditions for disability.  For other persons to qualify on the basis of blindness or disability, the person must have a physical or mental impairment which either (1) can be expected to result in death or (2) lasts for not less than 12 months.  The impairment must be of such severity that the person is unable to do his or her previous work and cannot (considering age, education and work experience), engage in other kinds of substantial, gainful work. 

The income standard (monthly income limit), after allowable deductions, is based on a percentage of the financial assistance grant level, as determined by the Utah State Legislature. 

Income Eligibility Standards in Monthly Amounts  (as of April 2005)            

Household Size  *Monthly Income       

1     . . . . . . . . . . .    $ 798                     
2     . . . . . . . . . . . .  $ 1070                          
3    . . . . . . . . . . . .   $ 1341                          
4     . . . . . . . . . . . .  $ 1613                      
5     . . . . . . . . . . . .  $ 1885 

For larger households, see Table: Income Limits for Medical Assistance and Medicare Cost-Sharing Programs                

*Deductions

Deduct $20.00 general income exclusion; $65.00 and 1/2 of the remaining gross earned income;  Health and accident premiums, and impairment-related work expenses. 

Income too high?  Medicaid applicants whose income is more than the monthly income standard may be considered for the Medically Needy program, sometimes referred to as the Spenddown Program.  This program allows a person who is otherwise eligible either to pay "excess" monthly income to the state or to accept responsibility for a portion of their monthly medical bills. There is also the QMB program for Medicare beneficiaries whose monthly income is too high to qualify for Medicaid.  See NOTE at bottom of page.

Asset Limits (see definition of "assets")

1 person   - $2,000.00
2 persons - $3,000.00
For each additional person, add $25.00.  Assets too high?  See NOTE at bottom of page.

Retroactive Coverage

Most Medicaid programs allow an applicant to request coverage for medical services for up to three months prior to the month in which the person filed a Medicaid application.  A person who received medical, dental or mental health services and subsequently qualifies for Medicaid may return to each provider with a Medicaid Identification Card for the month in which service was provided. A provider who has already rendered services may subsequently choose to accept Medicaid as payment in full or refuse to seek Medicaid payment because the patient had not been determined eligible for Medicaid at the time of service.  If the provider accepts Medicaid, Medicaid may pay for the service.  If the provider refuses Medicaid, the patient is responsible for the charges.

NOTE:   People who already qualify for Medicare but whose income or assets are too high to qualify for Medicaid are considered for the QMB Program. 

Another possible way to lower medical costs is by using a Federally Qualified Health Center.  This is a clinic that offers low-cost medical care.  It does not matter whether the person qualifies for Medicaid or has health insurance.  The cost of care is based on income.  There is a list of health centers in the brochure "Exploring Medicaid".  The brochure comes in two versions depending on where a person lives. One version of Exploring Medicaid is for people living in the Wasatch Front (Salt Lake, Utah,  Davis, Weber, and Morgan Counties).  The other version of Exploring Medicaid is for people who live in other areas of the state. In either version, look for telephone numbers for Federally Qualified Health Centers in the Resource section of the brochure.