Section 105 – Eligibility.

• (1) A child is eligible to enroll in the program if the child:
  • (a) is a bona fide Utah resident;
  • (b) is a citizen or legal resident of the United States;
  • (c) is under 19 years of age;
  • (d) does not have access to or coverage under other health insurance, including any coverage available through a parent or legal guardian’s employer;
  • (e) is ineligible for Medicaid benefits;
  • (f) resides in a household whose gross family income, as defined by rule, is at or below 200% of the federal poverty level; and
  • (g) is not an inmate of a public institution or a patient in an institution for mental diseases.

• (2) A child who qualifies for enrollment in the program under Subsection (1) may not be denied enrollment due to a diagnosis or pre-existing condition.

• (3)
  • (a) The department shall determine eligibility and send notification of the eligibility decision within 30 days after receiving the application for coverage.
  • (b) If the department cannot reach a decision because the applicant fails to take a required action, or because there is an administrative or other emergency beyond the department’s control, the department shall:
    • (i) document the reason for the delay in the applicant’s case record; and
    • (ii) inform the applicant of the status of the application and time frame for completion.

• (4) The department may not close enrollment in the program for a child who is eligible to enroll in the program under the provisions of Subsection (1).

• (5) The program shall:
  • (a) apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with Subsection (5)(b); and
  • (b) if funding is available, implement a simplified enrollment and renewal process.

Amended by Chapter 393, 2019 General Session