NOTICE OF SUBSTANTIVE CHANGE
TYPE OF FILING: Amendment
1. Agency Information
Health and Human Services, Integrated Healthcare
Salt Lake City, UT 84114-3325
2. Contact Persons
Please address questions regarding information on this notice to the persons listed above.
3. General Information
A. Rule or section catchline:
R414-302-8. Application for Other Possible Benefits
B. Purpose of the new rule or reason for the change:
This filing implements a change in policy that no longer requires an individual to apply for other financial benefits before applying for Medicaid.
C. Summary of the new rule or change:
This filing implements a change in policy that no longer requires an individual to apply for other financial benefits before applying for Medicaid.
It also removes provisions for modified adjustment gross income and Veterans Administration benefits that no longer apply to this rule.
5. Fiscal Information
Provide an estimate and written explanation of the aggregate anticipated cost or savings to:
The Department of Health and Human Services (department) estimates a total cost of about $262,747 based on an increase to the General Fund, its federal match, and an increase to the fund for Medicaid expansion in accordance with the Affordable Care Act.
There is no estimated savings to the state budget.
There is no expected fiscal impact on local governments as they neither fund nor provide services under the Medicaid program.
C. Small businesses ("small business" means a business employing 1-49 persons):
The department estimates an increase in revenue for small businesses based on an increase in eligibility and coverage for Medicaid members.
There is, however, no available data to estimate the number of individuals who will become eligible for Medicaid with the removal of the requirement to apply for other financial benefits, and it is impossible to know how many of those individuals will seek services from small businesses.
Therefore, this anticipated increase in revenue is considered inestimable.
There is no estimated cost to small businesses.
D. Non-small businesses ("non-small business" means a business employing 50 or more persons):
The department estimates an increase in revenue for non-small businesses based on an increase in eligibility and coverage for Medicaid members.
There is, however, no available data to estimate the number of individuals who will become eligible for Medicaid with the removal of the requirement to apply for other financial benefits, and it is impossible to know how many of those individuals will seek services from non-small businesses.
Therefore, this anticipated increase in revenue is considered inestimable.
There is no estimated cost to non-small businesses.
E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency):
The department does not expect this change to have a fiscal impact on entities outside of businesses or government because it only affects individuals who may qualify for services under the Medicaid program and providers of Medicaid services.
While this filing may increase the number of individuals who become eligible for Medicaid services, there is no available data to estimate the number of individuals who will become eligible for Medicaid with the removal of the requirement to apply for other financial benefits, and that number is inestimable.
F. Compliance costs for affected persons:
There are no anticipated compliance costs for small businesses, non-small businesses, or other persons, including individuals who may qualify for Medicaid services, as this change is expected to only result in out-of-pocket savings for an individual who qualifies for Medicaid and an increase in revenue for a provider of Medicaid services.
While the state is estimated to see a total cost of $262,747 based on an increase to the General Fund, its federal match, and an increase to the fund for Medicaid expansion in accordance with the Affordable Care Act.
However, because there is no available data to estimate the number of individuals who will become eligible for Medicaid with the removal of the requirement to apply for other financial benefits, the amount of an individualized compliance cost is inestimable.
6. Regulatory Impact Summary Table
Enter the cost or savings in the relevant cell. If there is no cost or savings, enter, "$0." If a cost or savings is inestimable, enter, "inestimable."
7. Regulatory Impact Analysis Approval
The Commissioner of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis.
8. Family Impact Information
A. The agency has considered this rule's impact on family health, stability, and formation:
9. Citation Information
Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement:
11. Public Notice Information
The public may submit written or oral comments to the agency identified in box 1.
A. Comments will be accepted until:
12. Effective Date Information
This rule change MAY become effective on:
(NOTE: This is the date the agency anticipates making the filing effective. It is NOT the effective date)
13. Agency Authorization Information
Agency head or
designee and title:
Tracy S. Gruber, Commissioner
R414. Health and Human Services, Integrated Healthcare.
R414-302. Eligibility Requirements.
R414-302-8. Application for [Other Possible Benefits]Medicare Part B. [(1) The department implements 42 CFR 435.608, which requires applicants for and members of medical assistance to apply for and take reasonable steps to receive other possible benefits. (2) The department may not require an applicant for or member of medical assistance to apply for an income benefit if the applicant's or member's income is not counted when determining eligibility for medical assistance for either that individual or any other household member. (3)]([a]1) An individual who may be eligible for Medicare Part B benefits must apply for Medicare Part B and, if eligible, become enrolled in Medicare Part B to be eligible for Medicaid. ([b]2) The state pays the applicable monthly premium and cost-sharing expenses for Medicare Part B for an individual who is eligible for both Medicaid and Medicare Part B.[ (4) An individual whose eligibility is determined using non-Modified Adjusted Gross Income (MAGI) methodologies and who may be eligible for a Veterans Administration (VA) apportionment payment of benefits, as defined by the VA, must apply for those benefits.] KEY: state residency, citizenship, third-party liability, Medicaid
Date of Last Change: [January 22, 2024]2026 Notice of Continuation: January 6, 2023
Authorizing, and Implemented or Interpreted Law: [26B-3-108; ]26B-1-213; 26B-3-108 !--dar--
