Superseded 1/1/2024)
Superseded 1/1/2024
26B-3-903. Eligibility.
| (1) |
A child is eligible to enroll in the program if the child:
Terms Used In Utah Code 26B-3-903- Applicant: means any person who requests assistance under the medical programs of the state. See Utah Code 26B-3-101
- Child: means an individual who is younger than 19 years old. See Utah Code 26B-3-901
- Process: means a writ or summons issued in the course of a judicial proceeding. See Utah Code 68-3-12.5
- Program: means the Utah Children's Health Insurance Program created by this part. See Utah Code 26B-3-901
- United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
| (a) |
is a bona fide Utah resident; |
| (b) |
is a citizen or legal resident of the United States; |
| (c) |
is under 19 years of age; |
| (d) |
does not have access to or coverage under other health insurance, including any coverage available through a parent or legal guardian‘s employer; |
| (e) |
is ineligible for Medicaid benefits; |
| (f) |
resides in a household whose gross family income, as defined by rule, is at or below 200% of the federal poverty level; and |
| (g) |
is not an inmate of a public institution or a patient in an institution for mental diseases. |
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| (2) |
A child who qualifies for enrollment in the program under Subsection (1) may not be denied enrollment due to a diagnosis or pre-existing condition. |
| (3) |
| (a) |
The department shall determine eligibility and send notification of the eligibility decision within 30 days after receiving the application for coverage. |
| (b) |
If the department cannot reach a decision because the applicant fails to take a required action, or because there is an administrative or other emergency beyond the department’s control, the department shall:
| (i) |
document the reason for the delay in the applicant’s case record; and |
| (ii) |
inform the applicant of the status of the application and time frame for completion. |
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| (4) |
The department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of Subsection (1). |
| (5) |
The program shall:
| (a) |
apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with Subsection (5)(b); and |
| (b) |
if funding is available, implement a simplified enrollment and renewal process. |
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Renumbered and Amended by Chapter 306, 2023 General Session
