§ 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 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)

(a) The program shall:

(i) apply for grants to make technology system improvements necessary to implement a simplified enrollment and renewal process in accordance with this Subsection (5); and

(ii) if funding is available, implement the simplified enrollment and renewal process in accordance with this Subsection (5).

(b) The simplified enrollment and renewal process:

(i) shall, in accordance with Section 59-1-403, provide an eligibility worker a process in which the eligibility worker:

(A) verifies the applicant's identity;

(B) gets consent to obtain the applicant's adjusted gross income from the State Tax Commission 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 the applicant; and

(ii) may not change the eligibility requirements for the program.

Amended by Chapter 344, 2011 General Session