Does Utah Have Medicaid? Income Limits and How to Apply

Utah Medicaid eligibility depends on which group you fit into and how your household income compares to the federal poverty level. Most adults aged 19 through 64 qualify if they earn up to 138 percent of the federal poverty level — about $22,025 a year for a single person in 2026.¹ Children, pregnant women, parents caring for dependent children, and people who are aged, blind, or living with a disability qualify under separate rules with different income thresholds. The program is run by the Utah Department of Health and Human Services, and applications go through the Department of Workforce Services.

Eligibility Groups

Utah Medicaid is not one program with one rule. Each group has its own income limit and, in some cases, its own asset test.² You need to find yourself on this list before anything else matters:

Adult Expansion: adults 19 through 64 who meet the income limit and do not qualify under another group.³
Children and CHIP: children from birth through 18. Medicaid covers them at lower incomes; CHIP picks up children in families earning somewhat more.
Pregnant women: covered from the start of pregnancy through the postpartum period.
Parents and caretaker relatives: adults caring for dependent children in the home.
Aged, Blind, or Disabled: people 65 and older, or those who are blind or living with a disability. This pathway includes an asset limit.

Income Limits for 2026

Almost every eligibility decision comes back to your household income measured against the federal poverty level (FPL), which HHS updates each January. For 2026, the guideline for a single person in the 48 contiguous states is $15,960 a year; for a family of four, it is $33,000.⁴

For the Adult Expansion group, the ceiling is 138 percent of the FPL, which works out to roughly $22,025 a year, or about $1,835 a month, for a household of one.¹ Pregnant women qualify at up to 139 percent of the FPL.⁵ Children qualify for Medicaid at incomes up to 133 to 138 percent of the FPL depending on age, and CHIP reaches families earning up to about 200 percent of the FPL if the children have no other insurance.

How Household Income Is Counted

For expansion adults, children, pregnant women, and parents, Utah uses Modified Adjusted Gross Income (MAGI). MAGI starts with the adjusted gross income from your tax return and adds back certain non-taxable income. These MAGI-based groups face no asset or resource test; only income counts.⁶

Household size is not always the people under your roof. If you file federal taxes, your Medicaid household generally includes you, your spouse if you live together, and anyone you claim as a tax dependent. If you do not file taxes, your household includes you, your spouse, and your children under 19 who live with you — not unmarried partners, their children, or extended family like grandparents.⁷ Because household size sets which FPL threshold applies, this can be the difference between qualifying and being denied.

Asset Limits for the Aged, Blind, and Disabled

People applying under the Aged, Blind, or Disabled categories face a resource test on top of the income rules. Countable resources cannot exceed $2,000 for an individual or $3,000 for a two-person household. Your primary home and one vehicle are generally excluded. If you qualify for the Medicaid Work Incentive Program, the resource limit rises to $5,000.⁶

If Your Income Is Too High: the Spenddown Option

If your income is over the limit but you carry heavy medical bills, Utah offers a Medically Needy pathway, known as Spenddown. The state compares your countable income to a set income limit and the difference is your spenddown amount. Once your medical expenses in a given period exceed that amount, Medicaid coverage kicks in.⁸ It functions like a deductible. This pathway applies to people receiving home and community-based services under specific waiver programs, so it is narrower than the general Medicaid program.

Residency and Citizenship

You must live in Utah with no immediate plans to leave, and you must be a U.S. citizen or national, or a qualified non-citizen under federal immigration law. People who meet every other requirement but lack documentation of citizenship or a satisfactory immigration status may still receive limited emergency Medicaid services.⁹

The state verifies much of what you report electronically, pulling from federal wage data, tax records, Social Security information, and immigration databases.¹⁰ If the state can confirm something on its own, it should not ask you for paper.

How to Apply

The main way to apply is the online portal run by the Department of Workforce Services (DWS). You can also mail a paper application to DWS or drop it off at a DWS employment center.¹¹ There is no enrollment window. Apply any time.

Before you start, gather this for each household member seeking coverage:

Social Security numbers for everyone applying.
Income verification: pay stubs from the last 30 days or your most recent federal tax return.
Proof of Utah residency: a utility bill, mortgage statement, or lease.
Citizenship or immigration documentation, if the state cannot verify it electronically.
Asset information, only if you are applying under the Aged, Blind, or Disabled category.

The application also asks about household composition, employment, and any existing health insurance. Missing information is the most common reason applications stall, so fill it out completely the first time.

Processing Time and Backdated Coverage

Federal rules give the state 45 days to process most Medicaid applications. Applications based on a disability can take up to 90 days.¹² A caseworker may reach out for missing details. When a decision is made, you get a written notice with your eligibility status, the effective date of coverage, any cost-sharing, and instructions for appealing.¹³

If you already had medical bills before you applied, Utah Medicaid can cover up to three months of expenses incurred before your application month, as long as you would have been eligible during those months.¹⁴ Coverage can start as early as the first day of the third month before you applied. This is worth knowing if you put off applying while dealing with an illness or injury.

Keeping Coverage: Annual Renewal

Eligibility does not carry forward automatically. The state must redetermine it every 12 months. When it can, the state renews you automatically using electronic data. When it cannot, it mails you a pre-populated renewal form and gives you at least 30 days to review, correct, and return it.¹⁵

Miss the deadline and lose coverage? You still have 90 days after termination to submit the renewal form, and the state treats it as a continuation rather than a fresh application.¹⁵ Losing coverage over a missed piece of mail is one of the most common and preventable problems. Watch your mailbox and the myCase portal around your renewal date.

If You Are Denied

If your application is denied, your benefits are reduced, or your coverage is terminated, you can request a fair hearing. You have 90 days from the date of the notice to file.¹⁶ Where you file depends on the type of dispute:

Eligibility disputes go to the Department of Workforce Services, Division of Adjudications.¹⁶
Disability determinations and other issues go to the DHHS Office of Administrative Hearings (OAH), by email at utmedicaidhearings@utah.gov or by mail.¹⁶
Managed care plan disputes require you to finish the ACO’s internal appeal process before filing with OAH.¹⁶

You can represent yourself or bring a lawyer, family member, friend, or other representative. You have the right to review your case file before the hearing and to question the state’s witnesses and evidence. The hearing officer must be someone who had no role in the original decision, and the ruling is based only on evidence presented at the hearing.¹⁷

1
ASPE – HHS.gov. 2026 Poverty Guidelines – 48 Contiguous States
2
Utah Department of Health and Human Services. Who Is Eligible – Medicaid
3
Utah DHHS. Medicaid Expansion
4
Federal Register. Annual Update of the HHS Poverty Guidelines
5
Utah.gov. Medicaid Eligibility State Plan – Pregnant Women
6
Legal Information Institute at Cornell Law School. Utah Administrative Code R414-305-3
7
Centers for Medicare and Medicaid Services. MAGI-Based Household Income Eligibility Training Manual
8
Cornell Law School. Utah Administrative Code R414-307-5 – Medically Needy Waiver Group
9
Utah.gov. Medicaid Eligibility – Citizenship and Non-Citizen Eligibility
10
Centers for Medicare and Medicaid Services. Financial Eligibility Verification Requirements and Flexibilities
11
Utah DHHS. Medicaid – Utah DHHS
12
Utah Department of Health and Human Services. Letter Regarding Unwinding Data Metrics
13
eCFR. 42 CFR 435.917 – Notice of Agency Decision Concerning Eligibility, Benefits, or Services
14
Utah.gov. 705-1 Determining the Retroactive Period
15
eCFR. 42 CFR 435.916 – Regularly Scheduled Renewals of Medicaid Eligibility
16
Department of Health and Human Services. Medicaid Fair Hearings
17
eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries