Section R414-303-4 - Medicaid for Parents and Caretaker Relatives, Pregnant Women, Children, Adults, and Individuals Infected with Tuberculosis Using MAGI Methodology(1) The Department provides Medicaid coverage to individuals who are eligible as described in 42 CFR 435.110, 435.116, 435.118, and 435.139, and 42 U.S.C. 1396a(a)(10)(A)(ii)(XII). The Department uses the MAGI methodology defined in Section R414-304-5 to determine household composition and countable income for these individuals.(2) To qualify for coverage, a parent or other caretaker relative must have a dependent child living with the parent or other caretaker relative.(3) The Department provides Medicaid coverage to parents and other caretaker relatives as required in 42 CFR 435.110, whose countable income is equal to or below the applicable income standard for the individual's family size. For a family that exceeds 16 persons, the Department adds $62 to the income standard for each family member. The income standards are as follows: TABLE
Family Size | Income Standard |
1 | $ 438 |
2 | $ 544 |
3 | $ 678 |
4 | $ 797 |
5 | $ 912 |
6 | $ 1,012 |
7 | $ 1,072 |
8 | $ 1,132 |
9 | $ 1,196 |
10 | $1,257 |
11 | $1,320 |
12 | $1,382 |
13 | $1,443 |
14 | $1,505 |
15 | $1,569 |
16 | $1,630 |
(4) The Department provides Medicaid coverage to children who are zero through five years of age as required in 42 CFR 435.118, whose countable income is equal to or below 139% of the FPL.(5) The Department provides Medicaid coverage to children who are six through 18 years of age as required in 42 CFR 435.118, whose countable income is equal to or below 133% of the FPL.(6) The Department provides Medicaid coverage to pregnant women as required in 42 CFR 435.116. (a) The Department elects the income limit of 139% of the FPL to determine a pregnant woman's eligibility for Medicaid.(b) An individual, as defined in Subsection R414-302-3(2), may only receive coverage through the end of the month in which the individual turns 19 years old.(7) The Department provides Medicaid coverage to an infant until the infant turns one-year old when born to a woman eligible for Utah Medicaid on the date of the delivery of the infant, in compliance with Sec. 113(b)(1), Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3. The infant does not have to remain in the birth mother's home and the birth mother does not have to continue to be eligible for Medicaid. The infant must continue to be a Utah resident to receive coverage. (8) The Department provides Medicaid coverage to an individual who is infected with tuberculosis and who does not qualify for a mandatory Medicaid coverage group. The individual's income cannot exceed the amount of earned income an individual, or if married, a couple, can have to qualify for Supplemental Security Income.Utah Admin. Code R414-303-4
Amended by Utah State Bulletin Number 2016-14, effective 7/1/2016Amended by Utah State Bulletin Number 2017-13, effective 7/1/2017Amended by Utah State Bulletin Number 2019-18, effective 8/29/2019