Utah Medicaid Rules 2020

Utah Medicaid Rules for 2020 are in and it is important to stay informed of the changes.

WHAT IS MEDICAID?
Medicaid is a health benefit program for families and individuals who are eligible. See What is Medicaid? brochure for general information about Medicaid. This pamphlet gives some of the rules of the Utah Long Term Care Medicaid program. When this pamphlet refers to nursing homes it is also referring to Intermediate Care Facilities for people with Intellectual Disabilities (ICF/ID). Medicaid rules are not always the same in each state. If you need to know about Medicaid in another state, you will need to contact a worker in that state. To apply for Utah Medicaid or get answers to your questions, you need to talk to a Nursing Home Medicaid worker. The people who work in the nursing home can tell you the name and telephone number of the Medicaid worker assigned to them or you can call 801-526-0950 in the Salt Lake area, or 1-866-435-7471 anywhere in Utah. You can also apply online at: jobs.utah.gov/mycase

WHO IS ELIGIBLE?
Medicaid will help pay for nursing home care for those individuals who are financially and medically eligible.

  • Financial: A Medicaid worker will determine if you are financially eligible for Medicaid. You will need to provide proof of your income (Social Security, retirement, veterans benefits, etc.) and your assets (bank accounts, property, stocks, cash on hand, etc.)
  • Medical: Your doctor and the nursing home will provide information about your health to the Department of Health. You must let the nursing home know you are applying for Medicaid as soon as possible. Both of these steps must be done before Medicaid can help with nursing home costs.

HOW DO I APPLY?
The first step to becoming eligible for Medicaid is to complete an application. You may apply in person at any Department of Workforce Services location, by mail, by fax or online at: jobs.utah. gov/mycase You will need to verify information about you and your spouse. You may be asked to provide a copy of the items listed below. If you need help with these proofs, please ask a Medicaid worker.

  • Proof of identity and citizenship—such as a passport or a driver’s license and a certified birth certificate; naturalization papers or other proof of identity and citizenship status; Medicare claim number and health insurance card.
  • Proof of total income for you and your spouse.
  • Proof of assets owned by you and/or your spouse including assets in which you and/or your spouse are a joint owner, signer, or trustee.
  • Copies of medical bills you owe or have just paid. See the back of this booklet for more information or questions on how to apply for Medicaid.

PAST MEDICAL BILLS
Income deductions: If your past bills are not covered by Medicaid or other insurance, you may be able to get a deduction for past medical bills you still owe. Please ask your worker about help for past medical bills.

DATES OF MEDICAID COVERAGE
Medicaid eligibility is decided one month at a time. Depending on changes of your income, assets, etc. you may be eligible for one month and not eligible during another month.

Utah Medicaid Rules

WHAT IS COVERED BY UTAH MEDICAID RULES?
Before you go to a doctor, pharmacy, hospital or other medical provider, ask if they accept Medicaid for payment. If they do not accept Medicaid you may have to pay for your services.

Nursing home — ICF/ID

  • Non-prescription pharmacy items
  • Dietary supplements
  • Transportation to medical appointments
  • Medical supplies
  • Room and board
  • Nursing care

People in ICF/ID facilities receive additional services such as employment training, counseling and support therapy, recreational activity training (eating in restaurants, going to movies, shopping in malls, etc.)

Hospital

  • Inpatient and outpatient hospital care
  • Physical therapy services
  • Pharmacy
  • Laboratory
  • X-Ray

Other services

  • Limited dental services
  • Oxygen
  • Emergency ambulance service
  • Doctor visits
  • Prescription drugs (reviewed if over 7 per month)
  • Most medical supplies
  • Limited vision coverage
  • Limited podiatry

Effective January 1, 2006 prescription drugs for Medicare eligible clients will no longer be covered by Medicaid.

MEDICAID NURSING HOME RESIDENT INCOME
The amount Utah Medicaid Rules for 2020 will pay on your nursing home cost depends on your income. You may be required to help pay the monthly costs. We look only at your income. If you have a spouse at home, we will see if your spouse can keep some of your income. You