Utah Medicaid: Eligibility, Application, Renewal & Special Programs

Medicaid is Utah’s primary health coverage program for low-income children, adults, seniors, pregnant women, and people with disabilities. This guide covers everything you need to know about Medicaid eligibility, covered groups, income and asset rules, how to apply (or renew), and navigating special Medicaid programs in Utah.
Updated for 2025.

Who Qualifies for Medicaid in Utah?

Medicaid eligibility in Utah depends on several factors: household income, assets (for some groups), age, disability status, and family situation. Each eligibility group has its own rules. Here’s a breakdown of the main covered groups with Utah-specific details and examples:

  • Children (0-18): Utah covers children under 19 in low- and moderate-income families. Income limit is about 205% FPL (higher for infants), with no asset test. See eligibility details.
    Example: A family of 4 with income below ~$5,400/month (pre-tax) may qualify. Even if parents are over the adult income limit, children can get Medicaid or CHIP.
  • Parents & Caretaker Relatives: Adults caring for a dependent child may qualify if their household income is below about 45% of the Federal Poverty Level (FPL)—in 2025, about $1,000/month for a family of 3. Eligibility is strict; single adults without children usually do not qualify unless disabled or pregnant.
    Example: A single mom with 2 kids earning $950/month may qualify. Earning $1,500/month, she would not.
  • Pregnant Women: Pregnant Utahns may qualify up to 144% FPL (plus a $100/month disregard). Coverage includes prenatal, delivery, and 2 months postpartum. More on pregnancy Medicaid.
    Example: A pregnant woman in a 2-person household earning up to ~$2,400/month may qualify.
  • Aged, Blind, or Disabled (ABD): Utah Medicaid covers adults 65+, and those who meet Social Security disability criteria, with income below about 100% FPL and limited countable assets ($2,000 individual/$3,000 couple). There are separate spend-down and "Medically Needy" options—see below.
    Example: An elderly couple with $1,800/month income and under $3,000 in countable resources can qualify.
  • Expansion Adults: As of 2020, Utah covers adults ages 19-64 with income up to 138% FPL under Medicaid expansion (about $1,730/month for a single adult in 2025). Citizenship/immigration restrictions apply. View expansion details.
    Example: A single adult earning $1,500/month may be eligible if all other criteria are met.
  • Special Groups: Foster youth (to age 26), former foster children, refugees, and certain women with breast/cervical cancer may qualify under special rules.
Income & Asset Rules: For most children and pregnant women, only income is counted. For aged/blind/disabled, both income and assets are considered. See full eligibility breakdown.
Real Example: A single mother with 2 children earning $2,700/month may qualify for child Medicaid but not for adult Medicaid.

Use the Utah Benefits Finder for a personalized eligibility check, or see documentation needed.

How to Apply for Medicaid in Utah

  1. Gather documents: Proof of identity, income, Utah residency, Social Security numbers, citizenship/immigration status. See documentation list.
  2. Apply online: Use the MyCase portal for fastest processing. You may also apply by mail, fax, or at your local DWS office.
  3. Interview & follow-up: DWS may contact you for additional info. Respond promptly to prevent delays.
  4. Approval: You’ll receive a written notice of eligibility. Most decisions take up to 30 days; emergency Medicaid may be faster.

Need help? Call 1-866-435-7414 or visit Utah Medicaid for official help.

What Does Medicaid Cover in Utah?

  • Doctor visits, hospital care, preventive care, X-rays, and labs
  • Prescription drugs
  • Dental (children, limited adult)
  • Vision and hearing (children)
  • Mental health and substance use treatment
  • Pregnancy care and birth
  • Long-term care/supports (aged, disabled)

Coverage may differ by group. See full benefit list.
Note: Most Utahns are enrolled in a managed care plan. Some groups (aged/disabled) may use "fee-for-service" Medicaid.

Special Medicaid Programs in Utah

  • Medically Needy (Spend-Down): If your income is above the regular Medicaid limit but you have high medical costs, you may "spend down" income to qualify. Learn about spend-down.
  • Buy-In for Working People with Disabilities: Working Utahns with disabilities can qualify for Medicaid by paying a premium, even if their income is higher than regular limits.
  • Emergency Medicaid: Provides limited coverage for emergencies, including labor and delivery, for non-citizens who otherwise meet Medicaid requirements.
  • CHIP: If your child doesn't qualify for Medicaid due to income, they may be eligible for CHIP (Children’s Health Insurance Program).

See Utah Medicaid Eligibility for full details.

Medicaid Renewal & What to Do if Coverage Stops

  • Renew every 12 months: Utah Medicaid requires yearly renewal. You’ll be mailed a renewal notice—respond quickly with updated income, household, and residency information.
  • Documents needed: Proof of income, address, household changes, and sometimes assets (for ABD groups). What to submit.
  • If coverage ends: You have 90 days to provide missing information. If denied and you believe it’s incorrect, request a fair hearing immediately.
  • Lost or interrupted coverage? Many Utahns lose Medicaid for missing paperwork. Contact DWS right away to fix common issues or reapply.
Tip: Check your mail and MyCase inbox often to avoid missed deadlines. For complex cases, get help from community organizations or your local DWS office.

Medicaid & Other Insurance: Coordination, Dual Eligibility, & Third-Party Liability

  • Medicaid is payer of last resort: If you have employer insurance, Medicare, or other coverage, Medicaid pays only after other insurance pays its share.
  • Dual Eligibility (Medicare & Medicaid): Seniors and people with disabilities who have both Medicare and Medicaid get help with premiums, deductibles, and coverage gaps. Utah offers Medicare Savings Programs for this purpose.
  • Third-Party Liability: You must report any other health insurance. Medicaid will coordinate benefits and may recover costs from liable parties (for example, after a car accident).

Real-World Utah Example: An older adult with both Medicare and Medicaid gets help paying for their Part B premium, prescriptions, and long-term care not covered by Medicare. If they also have VA coverage, Medicaid is billed last.

Utah Medicaid: Frequently Asked Questions

Most lawfully present immigrants may qualify after a 5-year waiting period. There are exceptions for pregnant women and children ("CHIP Medically Needy" and Emergency Medicaid). Undocumented immigrants may receive only emergency Medicaid (e.g., childbirth, emergencies). Detailed eligibility here.
You may qualify for the Medically Needy (Spend-Down) program if you have high medical bills. You pay or "spend down" the excess income on medical expenses, then Medicaid pays the rest. Learn more about spend-down.
Medicaid must be renewed every 12 months. DWS will mail you (or message via MyCase) a renewal notice. Submit updated info and documents by the deadline. If you miss it, you may lose coverage but can reapply within 90 days with no new application.
Yes, you may request retroactive coverage for up to 3 months before your application if you were eligible during that time. This helps cover old medical bills incurred before you applied.
Report changes (job loss, new baby, move, etc.) to DWS within 10 days. Your eligibility and benefit may be updated. Failing to report changes can lead to overpayments or loss of coverage.
DWS can sometimes help you verify information electronically. If a document is hard to obtain (e.g., missing birth certificate), let your DWS worker know. See alternatives and tips.
Yes, emergency out-of-state care is generally covered if you are traveling and have a true emergency. Always contact Medicaid or your managed care plan as soon as possible to report the situation and avoid claim denials.

More questions? See our full FAQ or explore Medicaid eligibility and documents required.

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