Utah Medicaid helps low-income residents get health care. It covers doctor visits, hospital stays, prescriptions, and more. The program is run by the Utah Department of Health and Human Services.
Knowing income limits is key in 2025. Health care costs are rising, so these limits decide who gets help. They update each year based on federal poverty levels. This guide reflects 2025 figures.
The program aids children, adults, pregnant women, seniors, disabled people, and low-income families. We’ll cover eligibility, income charts, special groups, and how to apply.
Utah Medicaid Income Limits Chart 2025
Income limits in Utah vary by household size and group. They use federal poverty level (FPL) percentages. For 2025, FPL is $15,650 annually for one person, adding $5,500 per extra member.
Most use modified adjusted gross income from taxes. Limits are higher for kids and pregnant women. Adults hit 138% FPL due to expansion. Check your group to see if you fit.
Here are the 2025 limits by category. Figures are monthly maximums at group FPL percent. Add $458 monthly per extra person beyond 8.
Utah Medicaid Income Limits 2025 (Monthly Income)
🏠 Household Size: 1 Person
- Adults (19–64) / Expansion Adults (138% FPL): $1,800
- Pregnant Women (139% FPL): $1,813
- Children (0–5): $1,813
- Children (6–18): $1,732
- Parents & Caregivers: $1,800
- Aged, Blind & Disabled (ABD – SSI level): $967
- Long-Term Care / Nursing Home (300% SSI): $2,901
- Children with Special Health Care Needs: $1,813
🏠 Household Size: 2 People
- Adults / Expansion Adults: $2,432
- Pregnant Women: $2,451
- Children (0–5): $2,451
- Children (6–18): $2,340
- Parents & Caregivers: $2,432
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $2,451
🏠 Household Size: 3 People
- Adults / Expansion Adults: $3,065
- Pregnant Women: $3,088
- Children (0–5): $3,088
- Children (6–18): $2,948
- Parents & Caregivers: $3,065
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $3,088
🏠 Household Size: 4 People
- Adults / Expansion Adults: $3,698
- Pregnant Women: $3,726
- Children (0–5): $3,726
- Children (6–18): $3,557
- Parents & Caregivers: $3,698
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $3,726
🏠 Household Size: 5 People
- Adults / Expansion Adults: $4,330
- Pregnant Women: $4,363
- Children (0–5): $4,363
- Children (6–18): $4,165
- Parents & Caregivers: $4,330
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $4,363
🏠 Household Size: 6 People
- Adults / Expansion Adults: $4,963
- Pregnant Women: $5,001
- Children (0–5): $5,001
- Children (6–18): $4,773
- Parents & Caregivers: $4,963
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $5,001
🏠 Household Size: 7 People
- Adults / Expansion Adults: $5,595
- Pregnant Women: $5,638
- Children (0–5): $5,638
- Children (6–18): $5,381
- Parents & Caregivers: $5,595
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $5,638
🏠 Household Size: 8 People
- Adults / Expansion Adults: $6,228
- Pregnant Women: $6,276
- Children (0–5): $6,276
- Children (6–18): $5,990
- Parents & Caregivers: $6,228
- ABD (SSI level): $1,450
- Long-Term Care / Nursing Home: $2,901
- Children with Special Health Care Needs: $6,276
✅ Quick Tips for Readers
- Amounts are monthly gross income limits
- Children have higher limits than adults
- Long-term care uses a fixed SSI-based limit
- ABD limits are much lower than expansion Medicaid
| Household Size | Adults (Age 19–64) (138% FPL) | Pregnant Women (139% FPL) | Children (0–18) (139% FPL for 0-5; 133% for 6-18) | Parents & Caregivers (138% FPL) | Aged, Blind, & Disabled (ABD) (SSI Level) | Long-Term Care / Nursing Home (300% SSI) | Medicaid Expansion Adults (138% FPL) | Children with Special Health Care Needs (139% FPL) |
| 1 | $1,800 | $1,813 | $1,813 (0-5); $1,732 (6-18) | $1,800 | $967 | $2,901 | $1,800 | $1,813 |
| 2 | $2,432 | $2,451 | $2,451 (0-5); $2,340 (6-18) | $2,432 | $1,450 | $2,901 | $2,432 | $2,451 |
| 3 | $3,065 | $3,088 | $3,088 (0-5); $2,948 (6-18) | $3,065 | $1,450 | $2,901 | $3,065 | $3,088 |
| 4 | $3,698 | $3,726 | $3,726 (0-5); $3,557 (6-18) | $3,698 | $1,450 | $2,901 | $3,698 | $3,726 |
| 5 | $4,330 | $4,363 | $4,363 (0-5); $4,165 (6-18) | $4,330 | $1,450 | $2,901 | $4,330 | $4,363 |
| 6 | $4,963 | $5,001 | $5,001 (0-5); $4,773 (6-18) | $4,963 | $1,450 | $2,901 | $4,963 | $5,001 |
| 7 | $5,595 | $5,638 | $5,638 (0-5); $5,381 (6-18) | $5,595 | $1,450 | $2,901 | $5,595 | $5,638 |
| 8 | $6,228 | $6,276 | $6,276 (0-5); $5,990 (6-18) | $6,228 | $1,450 | $2,901 | $6,228 | $6,276 |
Medicaid Expansion in Utah (2025 Update)
Utah expanded Medicaid in 2019 under the ACA. It covers adults 19-64 with incomes up to 138% FPL. This helps low-income workers without kids.
In 2025, no work requirements apply after a 2020 court ruling. You just need to meet income and residency rules. Expansion has helped over 100,000 Utahns get care.
Who Qualifies for Utah Medicaid in 2025?
You must live in Utah and plan to stay. U.S. citizens or qualified immigrants qualify. Qualified means green card holders after five years or refugees.
Income must be under your group’s limit. Age matters: Kids 0-18 have higher limits. Adults 19-64 use expansion.
Pregnancy gives higher limits with doctor proof. Disability needs Social Security or doctor verification.
Category eligibility:
- Children: Up to 139% FPL for 0-5, 133% for 6-18.
- Pregnant women: Up to 139% FPL.
- Parents: Up to 138% FPL.
- Disabled adults: SSI level or medically needy.
- Seniors: Same as disabled.
Required Documents for Utah Medicaid Application
Bring proof of identity like a driver’s license or birth certificate.
Show income with pay stubs or tax returns.
Prove Utah residency with a utility bill or lease.
Provide Social Security numbers for all.
For disability, bring medical records or Social Security award letter.
Pregnant applicants need a doctor’s note confirming pregnancy.
How to Apply for Utah Medicaid (Step-by-Step)
- Apply online at jobs.utah.gov/mycase for fast processing.
- Mail a paper form to your local Department of Workforce Services office.
- Call 1-866-435-7414 for phone help.
- Visit a DWS office in person for support.
Processing takes 45 days in 2025. For faster approval, submit all docs at once. Get temporary coverage if urgent.
Renewal Rules for 2025
Renew Utah Medicaid yearly to keep benefits. You’ll get a notice 45 days before due. Submit updated income and household info. Miss it, and coverage ends. To avoid interruption, respond fast. Auto-renew happens if data matches records. In 2025, no special pandemic rules apply.
What Medicaid Covers in Utah (2025 Benefits)
Utah Medicaid covers doctor visits and check-ups. It pays for prescription drugs. Hospital and emergency care are included. Mental health services like therapy are covered. Dental is full for kids, limited for adults. Vision includes exams and glasses for kids, basic for adults. Pregnancy services cover prenatal and birth care. Long-term care includes nursing homes and home aides. Home-based services help with daily living.
Common Reasons Utah Medicaid Gets Denied
- Income is too high for your group.
- Documents are missing or incomplete.
- You don’t meet residency or citizenship rules.
- Household size info doesn’t match.
- You didn’t respond to requests for more info.
How to Appeal a Medicaid Denial in Utah
- Appeal within 90 days of denial notice.
- Submit a written request to DWS or online.
- Include why you disagree and new docs.
- Expect a hearing within 60 days.
You can keep benefits during appeal if you request it.
Frequently Asked Questions (FAQ)
What are the Utah Medicaid income limits for 2025?
Limits vary: Adults $1,800 monthly for one at 138% FPL, kids up to $1,813 at 139%.
Does Utah Medicaid cover dental in 2025?
Yes, full for kids; adults get emergencies and basic care.
How do I apply for Utah Medicaid in 2025?
Online at myCase, by phone 1-866-435-7414, mail, or in person at DWS.
What is the income limit for a family of 4 in Utah for 2025?
Adults/parents: $3,698 monthly at 138% FPL.
Does Utah have Medicaid expansion in 2025?
Yes, for adults 19-64 up to 138% FPL.
How long does Utah Medicaid approval take in 2025?
Up to 45 days; 90 for disability.
Can I have Medicaid and private insurance in Utah?
Yes, Medicaid pays after private insurance.
Final Thoughts
Utah Medicaid makes health care affordable for those who need it. Knowing 2025 income limits helps you see if you qualify. Figures update yearly, so stay current. Apply early with all docs ready. Visit jobs.utah.gov/mycase for more. This guide gives you the tools, take action for your health.
