26-40-105 - Eligibility.
26-40-105. 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 anycoverage 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 below200% of the federal poverty level; and
(g) is not an inmate of a public institution or a patient in an institution for mentaldiseases.
(2) A child who qualifies for enrollment in the program under Subsection (1) may not bedenied enrollment due to a diagnosis or pre-existing condition.
(3) (a) The department shall determine eligibility and send notification of the eligibilitydecision within 30 days after receiving the application for coverage.
(b) If the department cannot reach a decision because the applicant fails to take arequired action, or because there is an administrative or other emergency beyond the department'scontrol, 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 toenroll in the program under the provisions of Subsection (1).
(5) (a) The program shall:
(i) apply for grants to make technology system improvements necessary to implement asimplified renewal process in accordance with this Subsection (5); and
(ii) if funding is available, implement the simplified renewal process in accordance withthis Subsection (5).
(b) The simplified renewal process:
(i) shall, in accordance with Section 59-1-403, provide an eligibility worker a process inwhich the eligibility worker:
(A) verifies the applicant's identity;
(B) gets consent to obtain the applicant's adjusted gross income from the Utah State TaxCommission from:
(I) the applicant, if the applicant filed a single tax return; or
(II) both parties to a joint return, if the applicant filed a joint tax return; and
(C) obtains from the Utah State Tax Commission, the adjusted gross income of theapplicant; and
(ii) may not change the eligibility requirements for the program.
Amended by Chapter 67, 2010 General Session