Medicaid Policy
Medicaid Policy
Effective Date: November 1, 2021
A. General Eligibility Requirements for MAGI- Based PCR and Family Medically Needy
A parent, a relative by blood, adoption or marriage of a dependent child who assumes primary responsibility for the child’s care could be eligible as a parent/caretaker relative if all of the following requirements are met. The section describes the eligibility criteria for the MAGI-based Parent Caretaker Relative (PCR) and Family Medically Needy programs. For Adult Expansion Medicaid see 348.
1. The individual must be a US citizen or qualified non-citizen (205).
2. The individual must meet Utah residency requirements (207).
3. There must be a dependent child in the household (345-1).
4. The individual must be related to the child (345-3).
· Take the client's statement on the relationship to the child unless the agency has information that contradicts the client's statement.
5. The child must be deprived of parental support (345-2).
6. If the only child in the household is an unborn child, and the woman is in her third trimester, see 345-1 for eligibility for both PCR and Family Medically Needy.
7. To establish relationship of the father when the couple is unmarried, see 229-1.
B. Family Medically Needy
Determine eligibility for Family Medically Needy for households that do not qualify for Parent/Caretaker Relative, 4-Month Extended or 12-Month Transitional. Spenddown is allowed.
1. There must be a dependent child in the household (345-1).
2. There must be at least one child who meets the deprivation of support criteria for the parent/caretaker relative to be eligible (345-2).
3. For Medically Needy household size see 404-1.
4. The Family Medically Needy program has an asset test. The asset limit is $3,000.00 for two people. Add $25.00 for every additional person.
5. To determine whose income to count for this program, see section 404-5. To calculate the countable income and the spenddown amount, see section 441-1.
6. Family Medically Needy households cannot qualify for the 12-Month Transitional or 4-Month Extended.
7. Before closing medically needy coverage, consider on-going eligibility for other medical programs, including Adult Expansion, Child Medicaid or CHIP. Someone who does not qualify for, or does not want, medically needy coverage, may look for a qualified health plan through the Federally Facilitated Marketplace (FFM) and apply for an Advanced Premium Tax Credit (APTC).