26B-3-142.6. Retroactive eligibility.

342 words·~2 min read·/ut/title-26b/chapter-3/26b-3-142-6

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 1/1/2027

(1)As used in this section:

(a)"Expansion population" means the population who is enrolled in the Medicaid program under 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII).

(b)"Traditional population" means the population who is enrolled in Medicaid under a provision of federal law that is not 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII), including pregnant women, children, elderly individuals, and individuals with disabilities.

(c)"Retroactive eligibility" means Medicaid coverage for services provided before the month of application, as authorized by 42 U.S.C. Sec. 1396(a)(34).

(a)The department shall limit retroactive eligibility for Medicaid benefits as follows:

(i)for the expansion population, Medicaid coverage may be made retroactive for no more than one month before the month in which the enrollee submits a completed Medicaid application; and

(ii)for the traditional population, Medicaid coverage may be made retroactive for no more than two months before the month in which the individual submits a completed Medicaid application.

(b)The limitations described in Subsection (2)(a) apply only to initial applications for Medicaid and do not affect eligibility for continuous or ongoing coverage.

(a)In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the department shall make rules necessary to implement and enforce the provisions of this section.

(b)The department may establish procedures to notify applicants and providers of changes in eligibility policy, and shall ensure compliance with all federal requirements regarding notice and due process.

(a)Beginning on August 31, 2027, and no later than August 31 of each subsequent year, the department shall submit an annual report to the Health and Human Services Interim Committee detailing the implementation and impact of the retroactive benefits limitation established in Subsection

(2).

(b)The report shall include for the prior fiscal year:

(i)the number of Medicaid applications processed for the expansion population and the number of applications processed for the traditional population; and

(ii)the estimated savings to the state created due to the benefits limitation established in Subsection

(2).

Enacted by Chapter 342 , 2026 General Session