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Medicaid, SCHIP, & Federal Authority

  • 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.

High-Risk Pools

  • In 1991, the state established the Utah Comprehensive Health Insurance Pool (HIPUtah), as a state-subsidized high risk pool.  The program specifically address’ the problem of people with serious medical conditions, such as cancer, diabetes, heart disease, and other chronic illnesses, that made them medically uninsurable and, as a result, unable to obtain medical insurance at any price.  As of March 2008, just over 3,500 people were enrolled.  This program is administered privately by SelectHealth.


Limited-Benefit Plans

  • In 2002, the legislature passed HB 122, which permitted insurance carriers to offer coverage that is similar to what is covered under Utah’s 1115 Medicaid waiver (Utah’s Primary Care Network).


Dependent Coverage

  • Passed in 1994, Utah requires insurance carriers to provide coverage for unmarried dependents until their 26th birthday. This requirement applies to dependents regardless of their educational status.

State Specific Strategies

  • In March 2008 Utah lawmakers passed legislation that slightly increases the state sales tax in order to offset a new five percent tax credit for health care costs paid by residents who do not have access to an employer-sponsored health plan.  Self-employed residents and others that purchase individual health plans are eligible for the state's health care tax credit.  The maximum amount for this nonrefundable credit is $300 for single taxpayers, $600 for married couples filing jointly, and $900 for taxpayers with dependants.