Utah Medicaid Office

Utah Medicaid office (DHHS)

Utah Medicaid sits inside the Department of Health and Human Services (DHHS) — the single agency that emerged from the 2022 merger of the former Department of Health and the Department of Human Services. DHHS pays for the program through its Division of Integrated Healthcare; a separate state agency, the Department of Workforce Services (DWS), runs eligibility determinations. That split shows up immediately when you call: questions about claims and benefits go to the Medicaid Information Line, and questions about whether you qualify go to DWS.

Medicaid Information Line and headquarters

• Salt Lake City area — (801) 538-6155
• Toll-free — 1-800-662-9651 (covers Utah, Idaho, Wyoming, Colorado, New Mexico, Arizona, and Nevada)
• Hours — Monday through Friday, 8:00 a.m. – 5:00 p.m. Mountain. Tuesday opens late, 11:00 a.m. – 5:00 p.m. Closed on state and federal holidays.
• Mail — Utah Department of Health and Human Services, Division of Integrated Healthcare, P.O. Box 143106, Salt Lake City, UT 84114-3106
• Physical address — Martha S. Hughes Cannon Building, 288 North 1460 West, Salt Lake City. The building is secure; the public may not enter secured areas unless accompanied by an employee.

Where to call for what

DHHS asks that you not send protected health information (PHI) to any Medicaid email address — the agency cannot guarantee email is intercepted-proof. Use the phone, the mail address above, or a secure portal for anything sensitive.

Who qualifies for Utah Medicaid?

Utah's Medicaid eligibility model has more categories than most states: more than 20 distinct program types are listed on DHHS's "Who Is Eligible?" page, and the monthly income standard varies between approximately 55% and 133% of the federal poverty level depending on which category fits the household. An individual must qualify each month for continued coverage — Utah does not lock eligibility in for a year except for children's continuous eligibility programs.

Utah adopted full Medicaid expansion in 2019

Utah voters approved Proposition 3 in the 2018 General Election to expand Medicaid up to 138% of the federal poverty level. The 2019 Legislature replaced Prop 3 with Senate Bill 96 ("the Fallback Plan"), and on December 23, 2019, CMS authorized the Utah Department of Health to implement a full Medicaid expansion. Adult Expansion eligibility requirements are short:

• Utah resident
• Age 19 through 64
• U.S. citizen or legal resident
• Meet income requirements (annual gross income up to 138% FPL — see the income-limits section for current dollar thresholds)

The state originally tried a smaller "Bridge Plan" at 100% FPL with a 70/30 federal match starting April 1, 2019, then moved to the full expansion at 90/10 once CMS authorized the broader waiver. CMS withdrew approval of Utah's Community Engagement (CE) work requirement on August 10, 2021; the CE requirement had taken effect January 1, 2020 but was suspended April 1, 2020 during the COVID-19 Public Health Emergency. CE has been removed from policy and rulemaking.

The full menu of Utah Medicaid categories

Utah's category structure is unusually long — DHHS publishes 20+ distinct program tracks. Read this as a directory of who is covered under what name:

• Children — Child Under Age 1, Child Age 0–5, Child Age 6–18, Child Medically Needy, Foster Care Medicaid, Child in Subsidized Adoption
• Pregnancy and parenting — Pregnant Woman, Medically Needy Pregnant Woman, Baby Your Baby, Parent / Caretaker Relative Medicaid, Family Medically Needy, 12-Month Transitional Medicaid
• Specific conditions and statuses — Individuals with Breast or Cervical Cancer (via screening program), Refugee Medicaid, Emergency Medicaid (limited coverage for non-citizens), Medicaid Work Incentive Program (for working adults with disabilities)
• Adults — Aged/Blind/Disabled (non-MAGI), Adult Expansion (ages 19–64 up to 138% FPL), Spenddown Program (Medically Needy)
• Medicare beneficiaries — Medicare Cost-Sharing Programs (QMB, SLMB, QI-1, QDWI)
• Long-term care — Medicaid for Long-Term Care and Waiver Programs (Nursing Facility, HCBS waivers)

Retroactive coverage and pre-application medical bills

Most Utah Medicaid programs allow an applicant to request coverage for medical services for up to three months prior to the month the person filed a Medicaid application. A person who received medical, dental, or mental health services and then qualifies for Medicaid can return to each provider with a Medicaid Identification Card for the month service was provided. A provider who has already been paid may choose to accept Medicaid as payment in full (and refund the patient), or refuse to seek Medicaid payment and keep the patient responsible for the charges — that choice is left to the provider.

Utah Medicaid income limits

Utah's adult Medicaid income chart updates every January when the federal poverty level resets, but the percentage standard (138% FPL for Adult Expansion) is stable. The figures below are verbatim from the DHHS Medicaid Expansion page maximum income guidelines table — useful as a current reference for adults aged 19–64 applying under expansion.

Adult Expansion income guidelines (138% FPL)

Other Medicaid categories use different income standards

Utah's published note is that the monthly income standard for non-expansion Medicaid programs varies between approximately 55% and 133% of the federal poverty level, depending on the category. Children, pregnant women, and people who are aged, blind, or disabled use their own income (and sometimes resource) tests. The Utah Medical Programs Summary PDF (published by DHHS, updated periodically) is the authoritative chart for category-specific income and asset rules.

What the 138% standard buys for newly eligible adults

The federal government covers 90% of the cost of Adult Expansion enrollees; the state covers 10%. Utah's expansion benefit package includes:

• Doctor, hospital, and emergency services
• Prescriptions
• Laboratory and X-rays
• Behavioral health services including addiction and recovery treatment
• Family planning services
• Maternity care
• Home health services
• Preventive and wellness services
• Chronic disease management services
• Dental

Employer-sponsored insurance buy-in

Utah requires newly eligible Adult Expansion adults to enroll in their employer-sponsored health plan if one is available. Medicaid then covers the individual's monthly premium and other out-of-pocket expenses such as co-pays and deductibles. This shifts the primary payer to the employer plan while keeping the Medicaid program responsible for the member's net cost.

How to apply for Utah Medicaid

Utah Medicaid applications are processed by the Department of Workforce Services (DWS), not by Medicaid itself. The split matters: DWS decides whether you qualify, requests proofs, and sends the eligibility decision; DHHS then handles your card, benefits, and any health-plan enrollment after approval. There are four ways to file, plus a separate marketplace path for non-Medicaid coverage.

Four ways to apply

• Online (fastest) — apply at jobs.utah.gov/mycase. If you apply online, you do not need to also complete a paper application.
• By mail — download the Medical Only Application (form 61MED), complete it, and mail to Department of Workforce Services, PO Box 143245, Salt Lake City, UT 84114-3245.
• By fax — fax the completed application to DWS at 801-526-9505 or toll-free 1-888-522-9505.
• In person — visit any DWS office. Find your nearest office at jobs.utah.gov/regions/ec.html.

Pick the right form

If you can't print the forms, call DWS to have one mailed: SLC area (801) 526-0950, toll-free 1-866-435-7414. To request a Medicaid information packet by mail (not a full application), call 1-888-222-2542.

What happens after you apply

When DWS receives your application, an eligibility worker will contact you by mail or phone. They may request additional proofs — typically birth certificates, pay stubs, citizenship or immigration documents, and information about other insurance. The federal Medicaid decision deadline is up to 45 days for non-disability applications and up to 90 days for applications based on disability. Pregnancy decisions can be same-day at qualified hospitals via presumptive eligibility. Coverage may be retroactive up to three months before the application month when you had qualifying medical bills.

If Medicaid isn't a fit — the Marketplace alternative

For households above the Medicaid income standards, the Federally-Facilitated Marketplace (HealthCare.gov, 1-800-318-2596) offers private health insurance with advance premium tax credits (APTC) for income between 100% and 400% FPL. The Marketplace application screens for Medicaid first; if anyone in the household appears eligible, the account transfers to DWS for a formal Medicaid decision without a separate application.

What Utah Medicaid covers

Utah Medicaid delivers care through two parallel networks: most members enroll in an Accountable Care Organization (ACO), the state's name for the contracted managed-care health plans; members who don't qualify for an ACO (or live in areas without one) receive care through the Fee-for-Service Network instead. Dental coverage is administered as a separate plan track. Most members navigate to their benefits through MyBenefits Login on medicaid.utah.gov.

Two delivery systems

• Accountable Care Organizations (ACOs) — Utah's name for the contracted managed-care health plans. DHHS publishes the current ACO roster on medicaid.utah.gov; pick one when you enroll, then use its in-network providers.
• Fee-for-Service (FFS) Network — for members who aren't in an ACO (some categories and certain geographies). FFS members can see any provider enrolled with Utah Medicaid.
• Dental plans — administered separately. Find a dental provider through the DHHS "Find a Dental Provider" tool and confirm which dental plan accepts you.

What Utah Medicaid covers

The Adult Expansion benefits list is the published baseline for the 19-to-64 population; children, pregnant women, and people with disabilities receive expanded EPSDT or category-specific benefits beyond this list.

• Doctor, hospital, and emergency services
• Prescription drugs
• Laboratory and X-rays
• Behavioral health, including addiction and recovery treatment
• Family planning services
• Maternity care
• Home health services
• Preventive and wellness services
• Chronic disease management
• Dental services
• Non-Emergency Medical Transportation (NEMT) to covered appointments
• Interpreter services at point of care

EPSDT and children's coverage

"Services Available for Children" on the DHHS members hub is Utah's name for the federal EPSDT mandate. Children under 21 enrolled in Utah Medicaid receive Early and Periodic Screening, Diagnostic, and Treatment benefits — every medically necessary service for a child, including dental, vision, hearing, and behavioral health that adult Medicaid does not always cover.

Long-term care and HCBS waivers

Members who need nursing facility-level care can apply through Medicaid for Long-Term Care and Waiver Programs. Utah's waivers include Aging Waiver, New Choices Waiver (community placement after a nursing facility stay), the Acquired Brain Injury Waiver, several Intellectual Disability waivers, and the Medically Complex Children's Waiver — each with its own functional and financial eligibility test. Start a waiver application or check status through DHHS Long-Term Care Programs.

Filing appeals and complaints

Members can request a hearing or file an appeal at medicaid.utah.gov/hearings. The first step for benefit-specific complaints is usually the member's health plan, the HPR at 1-866-608-9422, or the waiver case manager. If those channels can't resolve the issue, escalate to the Constituent Services Representative at (801) 538-6417 or 1-877-291-5583.

Other state Medicaid pages