Written by a parent, not a doctor. Nothing here is medical advice.

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Utah program

Free government health insurance for your child (Utah Medicaid)

Utah's free Medicaid plan for children under 19. It can sit behind insurance you already have.

What it is

Utah's free Medicaid plan for children under 19. It can sit behind insurance you already have.

A drop in pay can open Medicaid even when your child has work insurance. Utah decides who belongs in your child’s household and which income counts. A yearly income divided by 12 is only an estimate.

Eligibility rules
  • Your child must live in Utah and be under 19. Ordinary child Medicaid does not require a cancer diagnosis.
  • Utah uses your child’s tax-based household (MAGI), which may differ from everyone living at your address.
  • For four people the line is about $3,960 a month for a child under 6 and about $3,795 at ages 6 to 18. The worker applies a small deduction, so being just over is worth a conversation.
What you get
  • No premium for your child’s hospital care, cancer treatment and prescriptions.
  • Dental and vision care, with separate checks for home nursing and rides.
  • Eligible bills from before your application can also be covered.
What the help includes
  • For children under 21, EPSDT covers medically necessary care within federal Medicaid benefit categories. It does not guarantee every requested service.
  • Home nursing requires a separate clinical assessment. Rides follow transportation rules.
  • For a service covered by both plans, during active Medicaid coverage, an enrolled provider that meets Medicaid’s authorization and billing rules generally cannot charge you the work plan’s deductible, coinsurance or copay—even when Medicaid’s calculated payment is $0. A lawful Medicaid copayment or assigned spenddown is different. Noncovered care, dates without coverage and a valid advance agreement to pay for noncovered care need separate review; a provider’s billing or authorization error does not by itself make the bill yours.
  • Illustration, not a fee schedule: a covered outpatient service has a $5,000 private allowed charge and a $3,000 remaining deductible. The private plan pays $2,000; Medicaid’s allowed amount is $1,800. Medicaid pays $0, but the enrolled clinic cannot collect the $3,000 private deductible under the billing protections above. This assumes active coverage, required approvals, no lawful Medicaid copayment or assigned spenddown, and no valid noncovered-service agreement.
If you decide to apply
  1. Ask the hospital financial counselor to go through MyCase with you, including temporary hospital Medicaid.
  2. Have ready: this month’s pay, your child’s Social Security number, proof of address and insurance cards.
  3. Bring earlier medical bills and ask which health plans your child’s oncology team accepts.

1-866-435-7414 · Official page ↗

After you ask
  • The eligibility office’s notice gives the decision and coverage dates. Could the hospital counselor help you confirm the current Utah decision deadline and whether hospital presumptive eligibility is available while the full application is reviewed?
  • Hospital presumptive coverage starts when an authorized hospital approves it, not automatically on admission. Without a timely full application it generally ends on the last day of the following month; a timely application can keep it active until the eligibility decision.
  • Through 2026, coverage can reach back three calendar months before the application month, if eligible then. Applications from January 1, 2027 have a two-month child lookback.
  • Children generally receive 12 months of continuous eligibility, subject to program exceptions. In 13 counties, coverage involves choosing a health plan.
  • A decision is due within 45 days (90 when disability has to be decided).
Good to know

Work insurance pays first. For covered care, Medicaid billing protections can still apply when Medicaid pays nothing extra.

Other details
  • A waiver can use different financial rules if ordinary child Medicaid is unavailable.
  • Keeping work insurance preserves that plan’s access but also its premium. Medicaid alone requires checking the exact treatment team and pharmacy.

Federal background: Medicaid and Medicaid as second insurance.

Official sources
Ask your social worker

“Could Medicaid help with our child’s treatment bills alongside our current insurance? What would managing two plans involve, and could you help us decide whether to apply?”

Why I’m asking: I want to understand whether another health plan would reduce our bills without disrupting treatment.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on MyCase, report this month's income and any insurance, name the months that already have bills, and pick a plan the oncology team takes.

Your social worker

The hospital financial counsellor can open temporary Medicaid the same day and will help you file the full application.

The care team

Nothing for ordinary child Medicaid. Medical records matter for the waiver routes, not this one.

Who decides
Department of Workforce Services eligibility staff decide; Utah Medicaid and the health plan you choose run the coverage.
Ask your social worker
“Can you help me file on MyCase today, and can the hospital open presumptive eligibility now? Can we list the bills from the three months before this month?”

How to apply

First step: Apply at jobs.utah.gov/mycase or call 1-866-435-7414 this week, and ask the hospital counsellor today about temporary Medicaid.

  1. Apply on MyCase this week.
  2. Ask the Primary Children's financial counsellor today whether the hospital can open temporary Medicaid.
  3. List the months that already have bills so the three-month look-back covers the admission.
  4. Check that the oncology team is in whichever health plan you pick.

Official application / program page ↗

Where it starts: Apply on MyCase or call 1-866-435-7414. Ask the hospital's financial counsellor the same day about temporary Medicaid through hospital presumptive eligibility.

What to gather

  • Child's Social Security number and proof of Utah address
  • This month's pay for everyone in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before this one

How long: The manual gives the office 30 days, or 90 when a disability decision is part of it. Temporary Medicaid from the hospital can start the same day. Coverage reaches back up to three calendar months before the month you apply, two months for applications from January 1, 2027.

What a yes looks like

A notice with coverage dates and, in thirteen counties, a choice of health plan. Check the oncology team is in that plan before you choose. Then 12 months of continuous coverage.

What a no looks like, and the next move

Read whether the no is about income, a document or a category. If it is income, ask about the Medically Complex Children's Waiver by name and appeal by the date on the notice.

Watch out

  • Utah prints the line and the 5% deduction as two columns and says not to add them into one official ceiling; an income between the two is still worth applying for.
  • Your child can keep private insurance and have Medicaid too. Utah Medicaid pays after the primary insurer, so do not cancel the work plan.
  • If the office says income is too high, ask in the same breath about the Medically Complex Children's Waiver, which leaves parents' money out.

Dates that change this

2026-03-01: The income lines are Utah's March 1, 2026 tables. Utah updates them each March; the exact 2027 table and date were not published when this was written.

2027-01-01: Coverage reaches back up to three months before the application month now, and two months for applications from January 1, 2027. Utah has not published how it will apply the change. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Utah Medicaid with no premium for the child. For four people the published lines are $3,823 a month under six and $3,658 at ages six to eighteen, with a separate $137.50 deduction.

  • $3,823/month — Under six, household of 4, published base line (139%)
  • $3,658/month — Ages 6 to 18, household of 4, published base line (133%)
  • $137.5/month — Published 5% deduction cell, household of 4
  • $4,917/month — Ages 6 to 18, household of 6, published base line
  • $6,176/month — Ages 6 to 18, household of 8, published base line
  • $232.2/month — Published 5% deduction cell, household of 8

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21 through the state's EPSDT route · Private-duty nursing and home personal care when approved · Rides to appointments · Dental and vision

What it costs the family: No premium for a child.

The eligibility facts, as published

Age
under 19, in two age programs
Age max exclusive
19
Income
MAGI household; base lines 139% (birth through the month of the sixth birthday) and 133% (ages 6-18), with a separately published 5% deduction
Insurance status condition
none: other insurance can coexist and Medicaid pays second
Residency
Utah
Continuous eligibility
12 months for a child under 19, subject to stated exceptions
Retroactive months
3 now; 2 for applications from 2027-01-01
Processing standard
30 days; 90 days when a disability decision is part of it

Decisions this site cannot make: Department of Workforce Services eligibility decision · Hospital presumptive eligibility at an authorised hospital

Expect friction on: Choosing a health plan the oncology team is in · Mandatory managed care in thirteen counties

The trap: Utah publishes the income line and the 5% deduction as two separate columns and warns against adding them into one official ceiling. An income between the two is still worth applying for. Do not cancel private insurance to apply: Utah Medicaid pays second, behind it.

Where I read this

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