Eligibility.

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  • (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.




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