Effective 1/1/2024
26B-3-910. Alternative eligibility — Report — Alternative Eligibility Expendable Revenue Fund.
| (1) |
A child who is not a traditionally eligible child may enroll in the program if:
Terms Used In Utah Code 26B-3-910- Child: means an individual who is younger than 19 years old. See Utah Code 26B-3-901
- Eligible child: means a child who qualifies for enrollment in the program as provided in Section 26B-3-903. See Utah Code 26B-3-901
- Member: means a child enrolled in the program. See Utah Code 26B-3-901
- Program: means the Utah Children's Health Insurance Program created by this part. See Utah Code 26B-3-901
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
| (a) |
the child:
| (i) |
has been living in the state for at least 180 days before the day on which the child applies for the program; and |
|
| (b) |
the child’s parent has unsubsidized employment. |
|
| (2) |
| (a) |
Enrollment under Subsection (1) is subject to funds in the Alternative Eligibility Expendable Revenue Fund. |
| (b) |
The department may create a waiting list for enrollment under Subsection (2)(a) if eligible applicants exceed funds in the Alternative Eligibility Expendable Revenue Fund. |
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| (3) |
Notwithstanding Section 26-40-106, the program benefits, coverage, and cost sharing for a child enrolled under this section shall be equal to the benefits, coverage, and cost sharing provided to a child who:
| (b) |
resides in a household that has a gross family income equal to 200% of the federal poverty level. |
|
| (4) |
Notwithstanding Section 26-40-108, program services provided to a child enrolled under this section shall be funded by the Alternative Eligibility Expendable Revenue Fund. |
| (5) |
Each year the department enrolls a child in the program under this section, the department shall submit a report to the Health and Human Services Interim Committee before November 30 detailing:
| (a) |
the number of individuals served under the program; |
| (b) |
average duration of coverage for individuals served under the program; |
| (c) |
the cost of the program; and |
| (d) |
any benefits of the program, including data showing:
| (i) |
percentage of enrolled individuals who had well-child visits with a primary care practitioner at recommended ages; |
| (ii) |
percentage of enrolled individuals who received a comprehensive or periodic oral evaluation; |
| (iii) |
percentage of enrolled individuals who received recommended immunizations at recommended ages; |
| (iv) |
rate of emergency department visits per 1,000 member months; |
| (v) |
rate of medication adherence to treat chronic conditions; and |
| (vi) |
a comparison of utilization patterns before and after enrollment. |
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| (6) |
| (a) |
There is created an expendable special revenue fund known as the “Alternative Eligibility Expendable Revenue Fund.” |
| (b) |
The Alternative Eligibility Expendable Revenue Fund shall consist of:
| (i) |
appropriations by the Legislature; |
| (ii) |
any other funds received as donations for the fund; and |
| (iii) |
interest earned on the account. |
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| (c) |
If the balance of the Alternative Eligibility Expendable Revenue Fund exceeds $4,500,000, state funds shall be transferred from the Alternative Eligibility Expendable Revenue Fund to the General Fund in an amount equal to the amount needed to reduce the balance of the Alternative Eligibility Expendable Revenue Fund to $4,500,000. |
| (d) |
Money in the Alternative Eligibility Expendable Revenue Fund shall be used to provide benefits to a child enrolled in the program under this section. |
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Enacted by Chapter 332, 2023 General Session
Technical renumber instructions from Coordination Clause.
