Utah Medicaid Eligibility: Who Qualifies & Income Limits

Understand the full eligibility criteria for Utah Medicaid, including income limits, covered groups, asset rules, and documentation. Find out if you or your loved ones qualify, and learn how to navigate the application process with confidence.

Overview: Who Can Get Medicaid in Utah?

Utah Medicaid provides low-cost or free health coverage to eligible residents, including families, children, pregnant women, seniors, and people with disabilities. Eligibility is based on a combination of household income, family size, age, disability status, and other factors.

Children (0-18): Most Utah children qualify for Medicaid or CHIP if their household income is within state limits.
Pregnant Women: Pregnant women can qualify at higher income levels, with full coverage for prenatal, labor, and postpartum care.
Parents & Caretaker Relatives: Parents living with their children may qualify if household income is within limits.
Adults without Dependent Children: Some low-income adults qualify under the Medicaid expansion group.
Seniors (65+), Blind or Disabled: Those meeting Social Security or SSI disability criteria, and meeting income/asset limits, may qualify for Medicaid or QMB/SLMB (Medicare cost assistance).

See below for income limits, asset rules, and special groups. You can also use our Benefits Finder for a personalized eligibility check.

Utah Medicaid Income Limits (2025)

Medicaid income limits vary by household size and eligibility group. Income is measured using Modified Adjusted Gross Income (MAGI) for most groups, and "countable income" for the aged, blind, or disabled.

Group	Household Size	Monthly Income Limit*
Children (0-18)	1	$2,087
Children (0-18)	2	$2,823
Pregnant Woman	2 (self + unborn child counts)	$3,041
Parents/Caretaker Relatives	3	$1,144
Adult Expansion	1	$1,732
Seniors/Disabled (SSI-Related)	1	$943
Seniors/Disabled (SSI-Related)	2	$1,415

*These are sample limits. See the full Utah Medicaid Guide or use our Benefits Calculator for the latest numbers and a full breakdown by group and household size.

Medicaid Eligibility by Group

Children (0-18)

Utah children may qualify for Medicaid or CHIP depending on family income. Medicaid covers children up to 138% FPL, and CHIP covers up to 200% FPL. Both programs cover doctor visits, dental, vision, prescriptions, and more.

Pregnant Women

Pregnant women can qualify for full Medicaid if household income is below 144% FPL. Coverage includes prenatal care, labor and delivery, and extends up to 12 months postpartum.

Parents & Caretaker Relatives

Parents and caretaker relatives must have a dependent child in the home. Income limits are low (around 38% FPL), but if you are over limit, you may be eligible for Adult Expansion or premium subsidy.

Adults Without Dependent Children (Adult Expansion)

Utah expanded Medicaid in 2020. Adults age 19-64 without Medicare, not eligible under another group, and with income up to 138% FPL may qualify.

Aged, Blind, or Disabled (ABD/SSI-Related)

Utah residents who are 65 or older, legally blind, or meet Social Security disability standards may qualify if income and assets are within limits. Asset limits are $2,000 (single) or $3,000 (couple) for most ABD Medicaid. Some programs may allow higher assets or spousal protections.

Special Medicaid Programs

Medically Needy/Spend-Down: For those over income, can "spend down" excess income on medical bills.
QMB/SLMB: For Medicare enrollees, helps pay Medicare premiums or cost-sharing if low income.
PCN (Primary Care Network): Utah's limited coverage for adults who don't qualify for full Medicaid.

See program details or use our Benefits Finder for group-specific guidance.

Asset Rules & Required Documents

MAGI Medicaid (children, parents, pregnant women, expansion adults) has no asset test—only income is counted. SSI-related Medicaid (aged, blind, disabled) does have an asset limit. Exemptions include your primary home, one car, and basic household items.

When you apply, you'll need to provide proof of:

Identity (driver's license, birth certificate, passport)
Utah residency (lease, utility bill, mail)
Income (pay stubs, Social Security, self-employment records)
Citizenship or immigration status
Pregnancy (for pregnant women)
Disability (for ABD Medicaid, usually via SSA)

See our Documents Required guide for a full checklist.

How to Apply for Utah Medicaid

Apply online at Utah's MyCase portal.
Visit a local Department of Workforce Services (DWS) office in person.
Submit a paper application by mail (forms available on the Utah Medicaid site).

After applying, you'll receive a notice with your determination and next steps. You can check application status via MyCase or by contacting DWS.

If you are denied Medicaid, you may still qualify for CHIP for children or subsidized coverage through HealthCare.gov.

Utah Medicaid Eligibility: Frequently Asked Questions

Eligibility is primarily based on income, household size, and category: children, pregnant women, parents, adults without dependent children (expansion), seniors, and those who are blind or disabled. Some groups have different income and asset rules. See Utah Medicaid Guide for a full breakdown.

Most Medicaid programs for children, parents, pregnant women, and expansion adults do not have an asset test. Medicaid for the aged, blind, or disabled limits assets to $2,000 (single) or $3,000 (couple), not counting your home, one car, and some personal items.

If your income is slightly above the Medicaid limit for aged, blind, or disabled, Utah's "Medically Needy" program allows you to spend excess income on medical bills each month. Once you reach your spend-down threshold, Medicaid will cover the rest. See Medicaid Guide for more.

Lawful permanent residents (green card holders) may qualify for Medicaid after a five-year waiting period. Some refugees, asylees, and certain children or pregnant women may qualify sooner. Undocumented immigrants are generally not eligible, except for emergency Medicaid in life-threatening situations.

Utah Medicaid offers QMB and SLMB programs for low-income Medicare enrollees. QMB pays premiums, deductibles, and coinsurance. SLMB pays some or all Part B premiums. Income and asset limits apply. See Medicaid Guide for details.

For most groups, Utah uses MAGI (Modified Adjusted Gross Income), which includes wages, self-employment, unemployment, Social Security (but not SSI), and some other sources. Some deductions apply. For aged, blind, or disabled, SSI income rules are used instead.

Yes, you may be eligible for Medicaid even if you have other insurance, but Medicaid may pay last, covering costs not paid by your other insurance. This is common for people with Medicare or employer insurance who qualify based on low income.

You must report income changes to DWS within 10 days. If your income rises above the limit, you may lose Medicaid but could qualify for CHIP or subsidized private coverage. Some children and pregnant women receive 12 months of continuous coverage, even if income changes.

Free help is available from DWS offices, the Utah Health Policy Project, and community health centers. If denied, you have the right to appeal. See our Community Resources page for more.