Does Utah Have Medicaid? Income Limits and How to Apply

Utah Medicaid eligibility turns mostly on two things: which group you fall into and how your household income compares to the federal poverty level (FPL). Most adults aged 19 through 64 qualify if they earn up to 138 percent of the FPL, which works out to about $22,025 a year, or roughly $1,835 a month, for a single person in 2026.¹ Children, pregnant women, parents, and people who are aged, blind, or disabled qualify under separate rules with their own thresholds. You apply through the Department of Workforce Services at any time of year.

Which Group Do You Fall Into?

Utah Medicaid is not one program with one rule. Each category has its own income limit, and some have additional requirements.² Finding your group is the first step.

Adult Expansion covers adults aged 19 through 64 who meet the income limit and don’t qualify under another group.³
Children qualify for Medicaid at lower income levels and for CHIP at higher incomes, through age 18.
Pregnant women are covered from the start of pregnancy through a postpartum period.
Parents and caretaker relatives caring for dependent children in the home have their own pathway.
Aged, Blind, or Disabled covers people 65 and older, as well as those who are blind or living with a disability. This group has both income and asset limits.

Income Limits by Category

The federal government updates the poverty guidelines every January. For 2026, the guideline for a single person in the 48 contiguous states is $15,960 per year, and $33,000 for a family of four.⁴

From there, each group has a multiplier:

Adult Expansion: up to 138 percent of FPL, about $22,025 per year for one person in 2026.¹
Pregnant women: up to 139 percent of FPL.⁵
Children: up to 133 to 138 percent of FPL depending on age, with CHIP covering families up to about 200 percent of FPL who don’t have other insurance.

How Utah Counts Your Household and Income

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

Your Medicaid household isn’t necessarily everyone under your roof. If you file federal taxes, your household generally includes you, your spouse (if you live together), and anyone you claim as a tax dependent. If you don’t file, your household includes you, your spouse, and your children under 19 who live with you. Unmarried partners, their children, and extended family members like grandparents are not counted.⁷ Household size determines which FPL threshold applies, so getting it right matters.

Asset Limits for the Aged, Blind, or Disabled

Applicants in the Aged, Blind, or Disabled categories face a resource test. 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 limit rises to $5,000.⁶

If Your Income Is Too High: the Spenddown Option

Utah offers a Medically Needy pathway, sometimes called Spenddown, for people whose income exceeds the standard limits but who have significant medical bills. The state compares your countable income to a set limit and calculates the difference, which becomes your spenddown amount. Once your medical expenses in a given period exceed that amount, Medicaid picks up the rest. The pathway applies to people receiving home and community-based services under specific waiver programs.⁸

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 as defined under federal immigration law. Utah also provides limited emergency Medicaid services to people who meet every other requirement but lack documentation of citizenship or satisfactory immigration status.⁹

The state verifies much of what you report through electronic data sources, including federal wage records, tax data, Social Security information, and immigration databases.¹⁰ You may not be asked for paper proof of information the state can confirm on its own.

How to Apply

You can apply any time of year. There is no limited enrollment window. The main options are:

Online through the state portal run by the Department of Workforce Services (DWS).
By mail using a paper application sent to DWS.
In person at a DWS employment center.¹¹

Before you start, gather the following 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, such as a utility bill, mortgage statement, or lease.
Citizenship or immigration documentation, in case the state can’t verify it electronically.
Asset information, but only if you’re applying under the Aged, Blind, or Disabled category.

The application also asks about household composition, employment, and any existing health insurance. Missing information is one of the most common reasons an application takes longer than it should.

How Long It Takes and When Coverage Starts

Federal rules give the state 45 days to process most applications. Disability-based applications can take up to 90 days.¹² A caseworker may contact you during this time if something is missing. Once the state decides, you’ll get a written notice that includes your eligibility status, the effective date of coverage, any cost-sharing, and instructions for appealing.¹³

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

Keeping Coverage: Annual Renewal

Medicaid eligibility is reviewed every 12 months. When possible, the state renews your coverage automatically using electronic data. When it can’t, it sends you a pre-populated renewal form with the information already on file, and you get at least 30 days to review, correct, and return it.¹⁵

Miss the deadline and your coverage ends, but you still have 90 days to submit the renewal form. During that window, the state treats it as a continuation rather than a new application.¹⁵ Watch your mail and the myCase portal around your renewal date. Losing coverage because a letter went unread is common and preventable.

If You’re Denied

You have 90 days from the date of the notice to request a fair hearing on a denial, reduction, or termination.¹⁶ Where you file depends on the issue:

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

You can represent yourself at the hearing or bring a lawyer, family member, or other representative. You have the right to review your case file beforehand and to question any evidence or witnesses the state presents. The hearing officer must be someone who was not involved in the original decision, and the ruling is based only on what comes out 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