(1) As used in this section: (a) "Applicable individual" means an individual who: (i) is eligible to enroll in Medicaid under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); or (ii) (A) is eligible to enroll under a waiver that provides coverage that is equivalent to minimum essential coverage as described in 26 U.S.C. Sec. 5000A; (B) is at least 19 years old and younger than 65 years old; (C) is not pregnant; (D) is not entitled to, enrolled for, or eligible to enroll for, benefits under Part A of Title XVIII of the Social Security Act; and (E) is not entitled to, enrolled for, or eligible to enroll for, benefits under Part B of Title XVIII of the Social Security Act. (b) "Health care professional" means an individual practicing within the scope of the individual's professional license. (c) "Work requirements" means the requirements established by 42 U.S.C. Sec. 1396a(xx). (2) The department shall implement work requirements for applicable individuals. (3) (a) The department may not enroll an applicable individual in Medicaid unless, at the time of application, the individual demonstrates compliance with the work requirements for one month immediately preceding the month during which the individual applies. (b) The department: (i) shall use documentary evidence, including claims data; and (ii) may not rely exclusively on self-attestation as evidence. (c) The department shall verify an applicable individual's compliance with work requirements through state wage data, Department of Workforce Services records, education or training program enrollment, or verified volunteer service documentation. (d) The department shall verify that an applicable individual complied with work requirements for one month during the applicable individual's current eligibility period before completing the applicable individual's next redetermination of eligibility. (4) (a) An applicable individual seeking an exemption from work requirements shall provide documentation for the exemption sought unless the department is able to make the determination through other reliable sources of information. (b) The department: (i) shall verify all exemptions; (ii) may not accept exemption designations, approvals, or determinations by a managed care organization; and (iii) may accept data provided by a managed care organization to verify or make a determination regarding an exemption. (c) If the individual is attempting to obtain an exemption from the work requirements because the individual is medically frail or otherwise an individual with special needs, and electronic data is determined insufficient, the department may: (i) provisionally approve the exemption based on a diagnosis identified by the individual; and (ii) shall verify the exemption using electronic data or through a statement from a health care professional indicating the individual as: (A) being blind or disabled as defined in 42 U.S.C. Sec. 1382c(2) or (3); (B) having a disabling mental disorder; (C) having a physical, intellectual, or developmental disability that significantly impairs the individual's ability to perform one or more activities of daily living, which may include eating, dressing, bathing, grooming, getting in and out of bed and chairs, walking, going outdoors, or using the toilet; (D) having a substance use disorder; (E) having a serious or complex medical condition; or (F) experiencing homelessness. (5) Once work requirements are implemented, beginning August 31, 2027, and no later than August 31 of each subsequent year, the department shall submit annual reports to the Health and Human Services Interim Committee and the governor on compliance rates, the number and type of exemptions granted, and the impact on Medicaid enrollment.
‹ Prev All Utah sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.