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Utah Medicaid Guide

While Medicaid is a federal program, each state has some liberties to decide what’s covered, how it’s covered, and who is eligible. The Utah Medicaid program may be able to cover most of your healthcare needs at a minimal cost.

Click below to learn more about UT Medicaid:

Utah Medicaid's Accountable Care Organizations

Utah Medicaid currently works with four Accountable Care Organizations, which are sort of like health plans. Anyone in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber counties is required to select one of the four. Anyone in another county can choose an ACO but does not have to. The benefit of joining an ACO is that they might offer additional benefits that the Medicaid program does not provide on its own. The advantage of not selecting an ACO is that you can see any doctor that accepts Utah Medicaid insurance.

Anyone who lives in one of the counties listed above can change plans any time during their first 90 days. Additionally, anyone can change plans from mid-May through mid-June.

Steward Health Choice Utah

Steward Health Choice serves Beaver, Box Elder, Cache, Davis, Iron, Juab, Millard, Morgan, Rich, Salt Lake, Sanpete, Sevier, Summit, Toole, Utah, Wasatch, Washington, and Weber counties. The Stewards Health Care Network owns five hospitals: Davis Hospital and Medical Center (Layton, UT), Jordan Valley Medical Center (West Jordan, UT), Jordan Valley Medical Center West Valley Campus (West Valley City, UT), Salt Lake Regional Medical Center (Salt Lake City, UT), and Mountain Point Medical Center (Lehi, UT).

Healthy U

The Healthy U plan from University of Utah Health Plans offers statewide coverage, virtual healthcare appointments, a 24-7 nurse helpline, and more. They also specialize in Diabetes care and treatment and cover most exams, tests, and vaccinations related to your ongoing diabetes management.

Molina Healthcare

The Molina Healthcare Utah Medicaid plan will be on top of your healthcare management. They send member newsletters at least twice per year, they send appointment and regular screening reminders, and they have chronic disease management programs, like:

  • Breathe with Ease Asthma Program
  • Living with Diabetes Program
  • Living with Chronic Obstructive Pulmonary Disease (COPD) Program
  • Heart Healthy Living Program

Additionally, Molina uses Teladoc for no cost/no appointment needed virtual care appointments. You can use Teladoc for when you have cold or flu symptoms or for when you have other visible ailments that a doctor can diagnose via webcam, like skin conditions.

SelectHealth Community Care

The SelectHealth Community Care Plan services all Utah counties. This plan does require copayments, but there are out-of-pocket maximums that will prevent you from ever spending too much. You will not owe more than $20/month for prescriptions or $100/year for physician, hospital, and podiatry services. Some services, like emergency room visits, family planning, lab tests, immunizations, and other preventative services will not require a copayment.

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What Does Medicaid Cover in Utah?

The Utah Medicaid program offers comprehensive health benefits, including everything from your prescriptions to long-term hospital stays. It also includes full case management for mental health, starting with evaluations and moving through therapy, medication, and psychological treatment.

Dental

Dental benefits for Utah Medicaid members include preventive services like six-month checkups, cleanings, and X-rays as well as fillings, root canals, pullings, dentures, and surgical care/emergencies. Children can also get space maintainers and some orthodontic care.

Members in Davis, Salt Lake, Utah, or Weber counties who are either pregnant or qualify for CHEC (Child Health Evaluation and Care) will receive dental services through either MCNA Dental or Premier Access. Other Medicaid members can use the FDP (Family Dental Plan). FDP requires copayments for services.

Prescription Drugs

Since 2007, Utah has used a preferred drug list (PDL) to administer prescription benefits. As of 2009, doctors who want to prescribe you a non-preferred drug will need to seek prior approval from the state Medicaid program. Your drug list will vary based on whether you are in the regular Utah Medicaid program or an Accountable Care Organization. Each ACO has its own PDL.

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Non-emergency Medical Transportation

If you are eligible for Traditional Medicaid and do not have your own means of transportation, you can use the Utah Medicaid non-emergency medical transportation system. If you live in an area served by either UTA or Cedar Area Transportation Services (CATS), you can get a bus pass good for 12 one-way trips per year. The pass also works on light-rail and can only be used for getting to and from medical appointments. For help, call CATS at 435-865-4510 or FlexTrans. Salt Lake/Davis counties call 801-287-7433; Davis, Weber, and Box Elder call 1-877-882-7272.

If you do not live in a UTA or CATS serviceable area, you may be able to get transportation through LogistiCare. To use Logisticare, you must schedule your transportation at least three days in advance by calling 1-855-563-4403.

Baby Your Baby Utah

The Baby Your Baby Utah program, also known as BYB, provides temporary Medicaid coverage for low-income pregnant women. It covers pregnancy-related outpatient services but does not include delivery. The income guidelines for the Baby Your Baby program are a bit higher than those for Utah Medicaid. If you apply for Baby Your Baby and your BYB representative accepts you, your application stays active for Medicaid. If you are also deemed eligible for Medicaid, your coverage will continue after your baby is born. Otherwise, it will end after your pregnancy ends.

Baby Your Baby Utah Eligibility

Utah Medicaid Eligibility and Income Limits

To be eligible for Medicaid in Utah, you must be a legal resident of the state. Additionally, your income must be within the limits below (based on your family size and your grouping):

Baby Your Baby Utah Eligibility

Utah Medicaid Application

You can apply for Utah Medicaid either online, by mail, by fax, or in person. To apply in person, find a Department of Workforce Services (DWS) office near you. To mail or fax it, download the application (English/Spanish) and then either fax it to 1-888-522-9505 or mail it to the Department of Workforce Services at PO Box 143245, Salt Lake City, UT 84114-3245.

How to get Both Medicare and Medicaid in Utah

If you are eligible for Medicaid in Utah but also meet the qualifications for Medicare, you can benefit from both programs! You can qualify for Medicare by turning 65, by having ALS or ESRD, or by receiving disability benefits for at least 24 months.

If you do qualify for both programs, you can enroll in a Medicare Advantage Dual Special Needs Plan (DSNP). A DSNP can cover most or all of your health services at very little or no cost to you. DSNPs are unique to people who qualify for both Medicare and Medicaid and can be the cheapest way for you to get the coverage you need. However, there are hundreds of these plans available. For help finding the best plan in your county, speak with one of our licensed agents by calling 833-438-3676 or sending us a message.

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