DHHS - Medicaid Policy Manual
Click here to see this page in full context

  Medicaid Policy                                                                 

 

105 Rights of Applicants and Recipients

Effective Date: June 1, 2025

 

Previous Policy

 

 

To ensure applicants and recipients receive benefits to which they are entitled, Federal and State law specify:

  1. Individuals have the right to receive information about Medicaid, Medicare Cost-Sharing Programs and Utah's Premium Partnership (UPP). See 600 for information about program benefits and services.
  2. Individuals also have the right to receive information about related programs such as: other insurance affordability programs through the FFM, Advance Premium Tax Credits, EPSDT, CHIP, WIC, food stamps, energy assistance, financial assistance, employment planning, child care, skills training, etc. Individuals who are age 19-64 have the right to receive information explaining the benefits and eligibility requirements of the Disability Medicaid program.  
    1. Case managers and eligibility representatives should explain programs for which they determine eligibility, and offer referrals to appropriate agencies for more information about other related programs.
    2. Refer individuals to https://medicaid.utah.gov/additional-information/  for additional information regarding their rights and responsibilities.
  3. Allow individuals to apply or re-apply for medical assistance at any time with one exception: applications for the Utah's Premium Partnership will be accepted only during open enrollment periods.  If enrollment has been stopped for the Utah Premium Partnership program, and the individual does not appear to be eligible for another medical program, the worker will send a denial notice saying it is not an open enrollment period and that they can reapply during an open enrollment period.  
  4. Applicants may apply for medical assistance programs through the FFM.
  5. Inform individuals in writing, what additional information they need to provide before their eligibility for medical assistance can be determined.  Also tell them, in writing, the date by which the information must be provided.  The agency will always allow the individual at least 10 days to return information.  The written notice must clearly state what is needed and when it is needed.
  6. The eligibility agency cannot close or make a negative change without providing 10-day advance notice.  This includes action taken regarding reviews and case changes. See Section 811 for exceptions to the advance notice requirement.  
  7. Inform individuals at the time of application, and recipients at the time of review, that information from income match data systems will be used as part of the eligibility determination process. (See section 703 for definition of application)
  8. Inform applicants in writing, when their application is approved.  
  9. Provide a written notice to applicants and recipients telling them about actions taken which deny, reduce, terminate, or otherwise change benefits, the effective date of and the reason for such actions.  (See section 811 on proper notification.)
  10. That the eligibility agency must:
    1. Determine eligibility for medical assistance timely and correctly.
    2. Determine amount of member liability timely and correctly.
    3. Issue benefits timely and correctly.
    4. Fix medical assistance underpayments and overstatements of liability as required by the rules in 825.
    5. The electronic information will be sent to the FFM when Medicaid is closed or denied.
  11. Allow applicants and recipients to request a fair hearing when they disagree with an agency decision.  If the issue is simple and straightforward, inform applicants and recipients about the possibility of resolving the dispute through an agency conference.  
  12. When the Medicaid Disability Review Office decides an applicant or recipient is not disabled, inform the individual of his right to request a reconsideration of the decision as part of the request for a fair hearing. (See Sections 121 and 125 for rules about agency conferences and fair hearings.)
  13. Do not enter the home of applicants or recipients without their permission.  Do not visit an applicant or recipient after working hours without making an appointment.
  14. Keep applicants' and recipients' case record information safeguarded from unauthorized disclosure and use.  (See sections 111, 113, and 115 for more information.)
  15. Do not discriminate on the basis of race, color, religion, gender, age, national origin, political beliefs or handicapping conditions.  (Gender, age, disability and immigration status may affect eligibility for certain programs such as Pregnant Woman Medicaid, Child Medicaid, Aged Medicaid, Disability Medicaid or Refugee Medicaid Assistance.  Immigration status also affects whether a recipient can receive full Medicaid services or just emergency services.  However, these distinctions do not affect a person's right to apply for assistance or to receive a fair eligibility decision based on the applicable policies.  Questions about ethnic background are for statistical purposes only.)
  16. Provide auxiliary aids and services free of charge, in a timely manner, to individuals with disabilities.
  17. Provide language assistance services, free of charge, in a timely manner, to individuals with limited English proficiency.