Pregnant Women, Utah Medicaid Program

The Pregnant Women's Program is a medical assistance program for pregnant women whose monthly income is more than the income limit for the Prenatal program.  Women may pay a spenddown and receive Medicaid coverage.  The woman does not have to complete Duty of Support and name the father of the unborn child.  The child may qualify for Medicaid for 60 days after birth and for the first year under the Postnatal program.  The income standard, after allowable deductions, is based on a percentage of the financial assistance grant level, as determined by the Utah State Legislature.  Women who may not qualify should read the NOTE at bottom of page.

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. The $30 plus 1/3 of working income disregard 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?  See Spenddown below and also the NOTE at bottom of page.

*SpendDown RETURN TO TOP OF PAGE

Medicaid applicants whose income exceeds 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

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.
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NOTE: Other programs for Children and Pregnant Women

Baby Your Baby : Eligible pregnant women can receive prenatal care prior to establishing eligibility for Medicaid.  For more information, call the Baby Your Baby Hotline 1-800-826-9662  or l-800-662-9651.

CHIP (Child Health Insurance Program): Medical program for children who don't have medical insurance.  CHIP's Income limit is higher than Medicaid's and CHIP does not have an asset limit.  Call toll-free 1-888-222-2542.

Custody Medical Care Program: Medical program for a child in the custody of the State, similar to Foster Care.

Maternal and Child Health Programs, such as Immunzation, BabyWatch, Pregnancy Riskline, Women, Infants and Children (WIC) Program

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