Profile of Utah
Basic Program Information
| Medicaid | Separate CHIP | |
|---|---|---|
| Eligibility by age and income (% of FPL)1 | 0-5yr – up to 133% 6-18yr – up to 100% |
0-18yr – up to 200%* |
| No. of Children Ever Enrolled2 | 276,036 | 40,460 |
| FMAP3 | 71.13% | 79.79% |
| Premium Payment4 | None |
< 185 = $0 < 150 = $30 < 200 = $75 |
| Cost Sharing (Co-payments)5 | > 101% |
Plan A (0 to 100% FPL): Office Visits: $3 Plan B (100% to 150% FPL): Office Visits: $5 Plan C (150% to 200% FPL): Office Visits: $20 |
| Waiting Period6 | None | 90 Days |
| Premium Assistance7 | None | Yes |
Enrollment/Renewal Simplification Strategies8
| Medicaid | CHIP | |
|---|---|---|
| Joint Medicaid/CHIP Application | x | x |
| Face to Face Interview Not Required | x | x |
| Asset Test Not Required | x | |
| Express Lane Eligibility | Effective | April 2012 |
| Presumptive Eligibility | ||
| SSA Data Match | x | x |
| Online Application | x | x |
| Electronic Signature | x | x |
| Medicaid Systems Used for Other Assistance Programs | x | x |
| Integrated Medicaid/CHIP Eligibility System | x | x |
| 12 Month Continuous Eligibility | x | |
| Joint Medicaid/CHIP Renewal | Effective | Jan. 2012 |
| Telephone Renewal | x | x |
| Online Renewal | x | x |
| Express Lane Renewal |
*Medicaid's 0-5yr program does not require an asset test. For ages 6+, an asset test is required. Utah's SCHIP program does not require an asset test; it covers children who do not qualify for Medicaid, who are from 0 to 200% of FPL, and meet other eligibility criteria.
**Utah's SCHIP program has administrative renewal, but the eligibility worker may require a regular renewal if certain changes have occured such as changes in income, employer, household size, or insurance status.
Terms:
Joint Medicaid/CHIP Application:One application, instead of two separate forms, is used by the state agency to determine if an applicant is eligible for either Medicaid or CHIP.
Asset Test Not Required:The asset test sets a limit on the maximum amount of assets (i.e. home, vehicle, savings account) an applicant could posses in order to be eligible for Medicaid or CHIP. Eliminating the asset test means the state no longer considers the applicant’s assets to determine eligibility, but instead relies on income statements alone.
Express Lane Eligibility (ELE):The Express Lane Eligibility (ELE) provisions in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) enable state Medicaid and CHIP agencies to identify, enroll, and renew children by relying on eligibility findings from other programs such as Head Start, or SNAP rather than having to re-analyze eligibility under their own rules.
Presumptive Eligibility:This option allows states to permit designated qualified entities (schools, providers, health centers, hospitals, etc) to determine a child’s temporary eligibility for Medicaid or CHIP if the child appears eligible for the coverage. If the child is determined to be presumptively eligible, he/she can be temporarily enrolled in coverage, typically for up to 60 days, to obtain health services while the application process is completed by the Medicaid or CHIP state agency.
SSA Data Match:Created in the Deficit Reduction Act of 2005 (DRA) and extended to CHIP programs with CHIPRA, states are able to satisfy citizenship documentation requirements for Medicaid and CHIP programs through electronic data matches with the Social Security Administration’s (SSA) database.
On-line/Electronic Application:State has made application for coverage available to families on the internet, which makes the application process easier for working parents who have difficulty applying during conventional office hours.
Electronic Signature:In conjunction with an online application the state permits applicants to sign electronically by check box type process, a PIN number, a single string of numeric code that is encrypted etc. so no part of the application must be mailed or faxed.
12-month Continuous Eligibility:Designated set period of time that the state guarantees a child can remain covered under Medicaid or CHIP before requiring a re-determination of eligibility.
Telephone Renewal:State allows families to share and confirm eligibility information needed to renew coverage over the telephone, recording voice attestation and saving the recording.
Online Renewal:State established the opportunity for families to complete a simplified redetermination process online, which includes allowing families to safely and securely upload supporting documents (if needed) electronically.
Express Lane Renewal:Similar to when ELE is used in determining initial eligibility, state Medicaid and CHIP agencies can new children’s Medicaid and CHIP coverage by relying on eligibility findings from other programs such as SNAP rather than having to re-analyze eligibility under their own rules.
1 Federal Poverty Level (FPL)= Income amounts set each year by the U.S. Department of Health and Human Services used to determine whether a family’s income exceeds the “poverty level.” This standard is used as a threshold against which eligibility for federal and state low-income social welfare programs, including Medicaid and CHIP, is determined. Data from Kaiser State Health Facts. “Income Eligibility Levels for Children’s Regular Medicaid and Children’s SCHIP-funded Medicaid Expansions by Annual Incomes and as a Percent of Federal Poverty Level (FPL), 2009.” www.statehealthfacts.org (accessed February 4, 2009).
2 These numbers represent the number of children ever enrolled in the state’s Medicaid and CHIP program during fiscal year 2007 as reported by the state to the Centers for Medicare and Medicaid Services (CMS).
3 Federal Matching Rate (FMAP)= The Secretary of Health and Human Services calculates and publishes the FMAPs each year, which are used in determining the amount of federal matching funds for state expenditures for assistance payments for certain social services, and state medical and medical insurance expenditures. Data from Kaiser State Health Facts. “Federal Matching Rate (FMAP) for Medicaid and Multiplier, FY2009” and “Federal Matching Rate (FMAP) for SCHIP, FY2009.” www.statehealthfacts.org (accessed February 4, 2009).
4 Donna Cohen Ross and and Caryn Marks. Challenges of Providing Health Coverage for Children and Parents in a Recession: A 50 State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009. The Henry J. Kaiser Family Foundation, January 2009. Available online at http://www.kff.org/medicaid/7855.cfm.
6 Waiting period refers to the length of time the state requires a child to be uninsured before he/she is eligible for coverage. Data from Ross and Marks, 2009, and is available online at http://www.kff.org/medicaid/7855.cfm.
7 A state premium assistance program uses federal and state Medicaid and/or CHIP funds to help pay for a portion of the premium costs of employer-sponsored insurance or private health insurance for eligible populations. Premium assistance data for this table was provided by the state.
8 Information in this table comes from state-reported data and Kaiser State Health Facts. “Children’s Health Data.” www.statehealthfacts.org (accessed February 4, 2009) and Ross and Marks, 2009, available online at http://www.kff.org/medicaid/7855.cfm.