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BUYOUT
PROGRAM
If you are a person with current Medicaid
eligibility, available insurance, and a serious medical
need, your case may be reviewed for the Buyout Program.
The
Buyout Program is a Utah Medicaid program that purchases
established health insurance for Medicaid clients. Any Medicaid
(Traditional and Non-Traditional) recipient who has a significant
medical need and available insurance that would cover the
cost of that need may be referred to the Buyout Program.
In order for a client to be enrolled in the Buyout Program,
the Buyout staff must find that enrollment would be cost-effective
for the state. Most insurances are eligible, including but
not limited to employer-based group insurance, individual
plans, student health plans, etc.
The
primary considerations are eligibility for Medicaid, the
medical need, the coverage offered under the policy, and
the cost-effectiveness of the Buyout purchase. The Buyout
Program should not be confused with other programs such
as UPP, ARRA, or Buy-in (Medicare Premiums Assistance).
Buyout
policy allows for medical coverage only (unless significant
need is for dental care). Some examples of significant medical
need are:
-
Pending
surgery
-
Acute
illness such as AIDS, cancer, transplant candidates
-
High
pharmaceutical expenses
-
Maternity
-
Prematurity
-
Dialysis
-
Home
Health Care
Examples
of insurance policies Buyout pays for:
-
Employer-based
group insurance - Current employment of client, spouse,
or parent of a minor (Medicaid reimburses only the portion
of those individuals in the family who are eligible
for the Buyout Program).
-
COBRA
(continuation of benefits) after a "qualifying
event" (termination from employment, divorce from
the policyholder, marriage, or reaching the age of majority
of a dependent).
-
Student
Health Plans
-
Individual
Health Plans
-
Champus
- Tricare
If
you feel that you may qualify for the Buyout Program, please
notify your Medicaid caseworker.
If you have a specific question for the Buyout staff, send
an e-mail to medicaidops@utah.gov.
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