Medicaid - Part 2

Poverty level guidlines

The Federal Poverty Levels that determine income eligibility are 2005 Poverty Guidelines 100% FPL Persons in Family Unit 48 Contiguous States and D.C. Alaska Hawaii 1 $ 9,570 $11,950 $11,010

  • 12,830 16,030 14,760
  • 16,090 20,110 18,510
  • 19,350 24,190 22,260
  • 22,610 28,270 26,010
  • 25,870 32,350 29,760
  • 29,130 36,430 33,510
  • 32,390 40,510 37,260

For each additional person, add 3,260 4,080 3,750 SOURCE: Federal Register, Vol. 70, No. 33, February 18, 2005, pp. 8373-8375.

Financial eligibility is reexamined each month someone is on the program.

Federal guidelines for assets vary depending on the type of Medicaid eligibility but generally limit an individual to $2,000. A family has a more generous limit that starts at $3,000.

What services are available through Utah Medicaid?

The Federal government requires states to pay for certain mandatory health care services. States may also include additional (optional) services. Utah must submit a plan to the Federal government describing the health care services the state will offer. The Federal government must approve the plan. Once a person is determined eligible for Utah Medicaid, he or she is entitled to any medically necessary service offered in the state plan. Utah?s State Medicaid Plan can be found at http://health.utah.gov/medicaid/st_plan

Utah's State Medicaid Plan

Mandatory services:

  • Hospital Services
  • Inpatient hospital services except for services provided in an institution for mental illness
  • Outpatient hospital
  • Outpatient surgical centers
  • Free-standing birth centers
  • Rural health clinic services
  • Laboratory and X-ray services
  • Nursing home care
  • Child Health Evaluation and Care (CHEC) program providing early periodic screening diagnosis and treatment for children under 21 (the Federal EPSDT program)
  • Family planning services
  • Nurse midwife and nurse practitioner services
  • Physician services
  • Home health services
  • Transportation services for health care appointments

Optional Services:

  • Podiatric services
  • Optometry services (including eyeglasses)
  • Psychological services
  • Private duty nursing services for children under age 21
  • Clinic services
  • Dental services (including dentures)
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Prosthetic devices
  • Prescription medications and prescribed over-the-counter medications
  • Inpatient hospital services for mental illness
  • Intermediate care facilities for the mentally retarded (ICFs/MR)
  • Hospice care
  • Case management
  • Enhanced services for pregnant women
  • Translators for medical services for clients with limited English or disability
  • Medicare premiums for Part A and/or Part B for individuals who are dually eligible for Medicaid and Medicare

How do I apply for the Utah Medicaid Program?

You can apply for Medicaid at the Utah Department of Health Office or at Medicaid outreach offices found in major hospitals and public health clinics. You can find the location closest to you at: http://www.health.utah.gov/medicaid/provhtml/How%20and%20Where%20to%20Apply%20for%20Utah%20Medicaid.htm Follow the instructions and click on your zip code. You can apply on-line using this link. You can also call 801-538-6155 or toll free in Utah at 1-800-662-9651.

What documents do you need when applying for Medicaid?

  • Proof of alien status if you are not a U.S. citizen
  • Your social security number
  • Proof of income
  • Current bank statements
  • Proof of the value of any certificates of deposit (bank CDs), savings certificates, any real estate you own other than your personal home
  • Proof of the value of any stocks and bonds
  • Trust account papers
  • Copies of medical bills you owe or have recently paid
  • The name, address and policy number of your medical insurance company and the cost of your premiums

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