Effective Date: November 1, 2023

Previous Policy

The policies in section 300 explain the different Medicaid programs and the criteria a individual must meet to receive Medicaid. There are both non-financial and financial criteria.

The Medicaid programs have two main classifications:

· Programs using the Modified Adjusted Gross Income (MAGI) methodology; and

· Programs that do not use the MAGI methodology (non-MAGI).

When a member becomes ineligible for any medical program, always review the member for eligibility under other medical programs ( 827 ).

A. Categories of Coverage

Individuals must meet the criteria under one of the following categories of coverage to receive assistance under Medicaid. The categories of coverage are as follows:

· Aged (persons 65 and older)

· Blind or Disabled

· A parent or caretaker relative caring for a dependent child

· A child under age 19

· A pregnant woman

· Foster care children and children who aged out of foster care

· An individual with breast or cervical cancer

· A person with tuberculosis

· A refugee

· Medicare eligible individuals

· Adults age 19 through 64

B. MAGI Based Programs

1. Child ( 347 )

2. Non-IV-E Foster Care ( 354 )

3. Parent/Caretaker Relative ( 345 )

4. Adult Expansion ( 348 )

5. Pregnant Women (349 )

6. Targeted Adult ( 346 )

7. Tuberculosis Positive ( 392 )

8. UPP (Utah Premium Partnership) ( 1000 )

C. Non-MAGI Based Programs

1. Aged ( 303 , 329 )

2. Blind and Disabled ( 303 , 329 , 330 )

3. Breast and Cervical Cancer ( 390 )

4. Home and Community Based Waivers ( 380 )

5. Medicaid Work Incentive ( 314 )

6. Medically Needy ( 345 , 347 , 349 )

7. Medicare Cost-Sharing ( 320 )

8. New Choices Waiver ( 386 )

9. IV-E Foster Care ( 354 )

10. Nursing Home ( 370 )

11. Presumptive Eligibility ( 356 )

12. Refugee ( 394 )

13. Subsidized Adoption ( 355 )

14. 4-Month Extended and 12-Month Transitional ( 343 )