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Section 1115 Waiver - Utah’s Primary Care Network is a statewide Section 1115 demonstration to expand Medicaid coverage. The demonstration uses increased flexibility with current state plan eligibles to fund a Medicaid expansion to 25,000 uninsured adults between the ages of 19 and 64 with incomes up to 150 percent of the federal poverty level (FPL).  The expansion provides primary care and preventive services to low-income adults who would otherwise lack health insurance. Utah’s State Children’s Health Insurance Program (SCHIP) covers children under age 19 with family incomes up to 200 percent of the FPL.

In November 2006, the Centers for Medicare and Medicaid Services (CMS) approved a Health Insurance Flexibility and Accountability (HIFA) amendment to this waiver, establishing Utah’s Premium Partnership for Health Insurance (UPP). The UPP is a public-private partnership to reduce the number of uninsured individuals in the state through an employer-sponsored insurance program.  Qualified low-income workers and their families may receive up to $150 per adult and $120 per child on a monthly basis to help defray the cost of employer-sponsored insurance premiums if these premiums represent more than 5 percent of their annual income. Employers are required to pay at least half of the employee’s premium. The program provides funding for up to 1,000 adults with incomes up to 150 percent of the FPL and children with family incomes up to 200 percent of the FPL. As of March 2008, 195 adults and 326 children were enrolled in the program. UPP replaces an earlier program, entitled Covered at Work, which offered a monthly premium subsidy of $50.

The demonstration was renewed for an additional three years in July 2007.

To learn more about the Utah Primary Care Network, read SCI's Profile in Coverage.