Family Medicaid Program in Utah

Family Medicaid is a medical assistance program for families who meet the rules for the federal financial assistance program for families such as deprivation of support criteria. Generally, these families have only one parent who can work.  The other parent is either not in the home, or is not able to work for at least 30 days due to illness or injury, or is under-employed.  The income standard, after allowable deductions, is based on a percentage of the financial assistance grant level, as determined by the Utah State Legislature each year. 

If family income is over the monthly limit, children can usually qualify under one of several other programs.  There is also a separate program for pregnant women. Adults who qualify for Family Medicaid will be enrolled in the Non-Traditional Medicaid Program.

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

Household Size  *Monthly Income         Household Size     *Monthly Income

1     . . . . . . . . . . .    $ 382                             6     . . . . . . . . $   857
2     . . . . . . . . . . . .  $ 468                             7     . . . . . . . . $   897
3    . . . . . . . . . . . .   $ 583                             8     . . . . . . . . $   938
4     . . . . . . . . . . . .  $ 682                             9     . . . . . . . . $   982 
5     . . . . . . . . . . . .  $ 777                           10     . . . . . . . . $ 1,023 

*Deductions

Deduct $90.00 from the countable earned income of each working family member, child care expenses, health and accident premiums.  Deduction of $30.00 plus 1/3 of working income may be allowed only if a client has received this deduction under a type of Family cash assistance in one of the last four months. 

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.

Asset Limits (see definition of "assets")

1 person   - $2,000.00
2 Persons - $3,000.00
For each additional person, add $25.00 

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.

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