343-1 4 Month Extended Medicaid

Effective Date: January 1, 2025

Eligibility for 4 Month Extended Coverage

Four months of extended Medicaid is available to the following individuals who would otherwise lose eligibility due to a change in spousal support income.

A parent/caretaker relative who has received PCR coverage in 3 of the last 6 months;

A pregnant woman whose income does not exceed the PCR income limit in 3 of the last 6 months; however, if there are no other children besides the unborn, the 3 months must occur during the 3rd trimester or the post-partum period;

Any dependent child in the household who is included in the parent's household; and

Any child born into the household during the 4-month Medicaid, unless the infant qualifies for the Child 0-1 coverage group.

Increased Spousal Support Income

Provide extended Medicaid for 4 months when a parent or caretaker relative, or eligible pregnant woman, has an increase in spousal support income that causes income to exceed the PCR limit. An increase in child support will not cause PCR Medicaid to close because child support is not counted as income under the MAGI-based income rules.

Other Requirements

The household must continue to meet Utah residency requirements and there must be at least one dependent child in the home.

Any other changes in household circumstances do not affect eligibility during the 4 months of extended coverage.

There is no deprivation requirement during the 4-month extended Medicaid. If an absent parent returns to the home, add the absent parent to the coverage.

There is no asset test.

When to Begin 4 Month Extended Medicaid

4 Month Extended Medicaid begins with the month following the month of the PCR Medicaid closure. If the household receives an extra month of PCR Medicaid because of the 10 day notice requirement, count that month as the first month of 4 Month Extended Medicaid.

Changes During 4 Month Extended Medicaid

Close the program if the household moves out of state. The household may receive Medicaid for any of months left in the initial 4 month period if the household returns to the state of Utah before the end of the four months.

Eligibility for 4 Month Extended ends if there is no longer a dependent child residing in the household.

When a new baby is born to a mother on 4 Month Extended Medicaid that child is born to a Medicaid mother and is eligible for Child 0-1 (347).

Add a new household member that moves in to the 4 Month Extended Medicaid if that person is a spouse of the parent or caretaker relative, or a dependent child who fails the income test for the MAGI-based Child Medicaid program.

If a household member moves out, remove the household member from 4 Month Extended Medicaid unless the absence is only temporary.

Complete an eligibility review at the end of the 4 Month Extended period (721).

Before terminating the coverage of members on 4 Month Extended Medicaid, for any reason, re-determine eligibility for other Medicaid programs for each household member. Move the household members to the appropriate Medicaid program before closing the 4 Month Extended program (827).

All recipients who are losing coverage under this program will need to have all factors of eligibility addressed in order to determine ongoing eligibility. If the member is eligible for another program a new 12-month certification period will be given.

Exception: Recipients who are pregnant or within their postpartum period cannot lose coverage prior to the end of the postpartum period and will continue their coverage on the Pregnant Woman program unless they are found eligible for a better program. The certification period for this member will end at the end of the postpartum period.

A due process month will need to be issued if ongoing eligibility is not determined with sufficient time to give proper notice. See 811-1