Next Generation Portal

The Department of Technology services will build an ecosystem of related services that will make up the Citizen Portal.  More than an initiative to build a website that links out to the existing agency services, the Citizen Portal is a group of services that are designed to work together to simplify and consolidate duplicate functions for agencies with the goal of making it much simpler for citizens to interact with state agencies.  The Citizen Portal will have the following key components:  

Excerpts from SB 137 

  63F-3-103.5. Single sign-on citizen portal — Creation.

164          (1) The department shall, in consultation with the entities described in Subsection (4),

165     design and create a single sign-on citizen portal that is:

166          (a) a web portal through which an individual may access information and services

167     described in Subsection (2), as agreed upon by the entities described in Subsection (4); and

168          (b) secure, centralized, and interconnected.

169          (2) The department shall ensure that the single sign-on citizen portal allows an


170     individual, at a single point of entry, to:

171          (a) access and submit an application for:

172          (i) medical and support programs including:

173          (A) a medical assistance program administered under Title 26, Chapter 18, Medical

174     Assistance Act, including Medicaid;

175          (B) the Children’s Health Insurance Program under Title 26, Chapter 40, Utah

176     Children’s Health Insurance Act;

177          (C) the Primary Care Network as defined in Section 26-18-416; and

178          (D) the Women, Infants, and Children program administered under 42 U.S.C. Sec.

179     1786;

180          (ii) unemployment insurance under Title 35A, Chapter 4, Employment Security Act;

181          (iii) workers’ compensation under Title 34A, Chapter 2, Workers’ Compensation Act;

182          (iv) employment with a state agency;

183          (v) a driver license or state identification card renewal under Title 53, Chapter 3,

184     Uniform Driver License Act;

185          (vi) a birth or death certificate under Title 26, Chapter 2, Utah Vital Statistics Act; and

186          (vii) a hunting or fishing license under Title 23, Chapter 19, Licenses, Permits, and

187     Tags;

188          (b) access the individual’s:

189          (i) transcripts from an institution of higher education described in Section 53B-2-101;

190          (ii) immunization records maintained by the Utah Department of Health; and

191          (iii) previous years’ tax filing information from the State Tax Commission;

192          (c) register the individual’s vehicle under Title 41, Chapter 1a, Part 2, Registration,

193     with the Motor Vehicle Division of the State Tax Commission;

194          (d) file the individual’s state income taxes under Title 59, Chapter 10, Individual

195     Income Tax Act;

196          (e) access information about positions available for employment with the state; and

197          (f) access any other service or information the department determines is appropriate in


198     consultation with the entities described in Subsection (4).

199          (3) The department shall develop the single sign-on citizen portal using an open

200     platform that:

201          (a) facilitates participation in the portal by a state entity; and

202          (b) allows for optional participation in the portal by a political subdivision of the state.

203          (4) In developing the single sign-on citizen portal, the department shall consult with:

204          (a) each state executive branch agency that administer a program, provides a service, or

205     manages applicable information described in Subsection (2);

206          (b) the Utah League of Cities and Towns;

207          (c) the Utah Association of Counties; and

208          (d) other appropriate state executive branch agencies.

209          (5) The department shall ensure that the single sign-on citizen portal is fully

210     operational no later than January 1, 2025.

Rephrasing the Legislation:

It may be helpful as we break down the legislation into its required parts to restate the legislation into a more readable format.  The following is a close interpretation that the reader may find more understandable: 

Create a single sign-on citizen portal that is:

Develop the single sign-on Citizen Portal using an open platform that:

DTS should consult with

The single sign-on Citizen Portal is fully operational no later than January 1, 2025.

Defining the Citizen User

In order to build an effective portal, it is necessary to understand who the users of the system may be.  We need to answer questions like: What is a citizen of Utah? Who are they? What needs do they have? When do they interact with government services?

These questions will be answered throughout this plan as well as Plan 7.    

Many of the social services are focused on low income children and their parents or to individuals with disabilities.  Some services are only available to children. Some services are beneficial to those entering the workforce along with those that are in the workforce and want to stay in the workforce.  Other services are only available to those over age 65.  

Because many of these services are targeted at specific groups to the exclusion of other groups it is highly unlikely that a single user will need all of the services at any single point in time. There is likely no one in Utah that is a blind, pregnant, single mother over the age of 65 with foster children that holds a driver license, a hunting license, and is an employee of the state.  It is much more likely that the majority of users may use two or three services with the state. Because of this, the system should be customizable for each user so that the most relevant services are easily found and displayed while unneeded services fade out of focus for each user.

Single Sign-On

The starting point of centralizing a user’s services is to create a single account or profile for each user that works across all government systems.  DTS has already spent years moving toward a single system for users to create a universal account that can be used across all systems. To achieve this, the single account for each user would have a unique identification number that each agency system can use to record each interaction that a user has.  When a user logs into any agency system connected by a Single Sign-On process, that system will be able to record the same Utah.Gov user ID. This would allow the state to query multiple systems about a user and provide to the user certificates, receipts and a history about what services they have interacted with.

The single account will also simplify the experience for users who previously needed to create multiple new accounts for each time they interact with a different agency.   With a standard sign-in, the main Utah.gov page as well as agency sites could use a standard header that includes the ability to sign in and use their universal account. 

Utah.gov Home Page–Citizen Portal Description

Utah.gov Home Page–User Logged into Citizen Portal

Utah.gov Home Page–Service Highlight

Accessibility Policies 

The Citizen Portal must comply with all of the state’s guidelines for web development and any standards for security, privacy, accessibility, and usability. The portal’s content must also meet or exceed the state’s desired accessibility compliance and adhere to Section 508 and other accessibility guidelines concerning government websites. 

The state has an accessibility policy listed in a standard footer that links to:

https://www.utah.gov/accessibility.html  DTS has augmented that policy with specific standards and guides to help any group that is building services for the state that are further outlined at https://dts.utah.gov/wp-content/uploads/UtahWebStandards-S4-013111.pdf

The Web Content Accessibility Guidelines (WCAG) were defined by The World Wide Web Consortium (W3C),  who is an international community that develops open standards to ensure the long-term growth of the Web.

The current standard, WCAG 2.1 is found at:   

https://www.w3.org/TR/WCAG21/
https://www.w3.org/WAI/WCAG21/quickref/

Several layers of guidance are provided by WCAG including these principles and guidelines.  

13 WCAG Guidelines:

The Citizen Portal needs to follow those guides and standards to be inclusive, especially for those with disabilities or to those who may be unfamiliar with the English language by following the W3C recommendations, Section 508, and the Americans with Disabilities Act.

The Citizen Portal should automatically check of accessibility of each participating service prior to each deployment to production.  This automatic check should be completed by a consistent quality assurance team using automation tools such as Selenium’s AxeCore.  

Each state website and application tied to the Citizen Portal should be validated based on the current Web Content Accessibility Guidelines (WCAG) version 2.1. 

Further validation services from WebAIM such as their extensions for Chrome and Firefox should be utilized by each system’s front-end developers and the respective Quality Assurance team.

Compliance with forward compatibility helps to ensure that sites work properly across multiple browsers, platforms, and Internet devices. Standards-compliant sites generally require less production and maintenance resources and are more accessible to those with special needs. As a result, standards-compliant pages readily adhere to Section 508 requirements for accessibility.

The Citizen Portal Quality Assurance team will need to test code for a variety of user experiences in addition to browser compatibility, 508 compliance, and mobile compatibility. The 508 Accessibility Standards tests are completed using independent accessibility audit tools including: WebAim and Functional Accessibility Evaluator 2.0.

The Citizen Portal should abide by the following guiding principles when redesigning Utah’s user interface for the portal system:

User Focus: The citizen user as an owner of government, not just a customer of its services, is the first consideration when designing and implementing the portal. It is impossible to engineer an effective government web portal without considering the individual user. Likewise, business users have special needs in accessing government information and are often the most frequent consumers of online services. These user groups and other special user groups must all be considered when redesigning the portal.

Usability: Information posted on a website serves no purpose if users cannot find it. Focusing on how users interact with a website and discovering what information is most commonly sought should drive the creation of an appropriate and effective information architecture and navigation scheme. In particular, we focus on categorizing information in a logical manner that does not force citizen users or businesses to understand the intricacies of government. The objective of a highly usable state portal is to demystify the levels and classifications of government and provide multiple ways to easily access important information.

Accessibility: Accessible sites have a user interface that takes into account the needs of users with disabilities.  Accessibility is by definition a category of usability–when the user interface is accessible to those with disabilities, it is also more usable for everyone.

Consistency: The portal will be implemented with consistent navigation and layout elements to promote an intuitive and seamless user experience. Consistency is core to usability and is also essential for site recognition and brand awareness.

Cutting Edge Technology: As user experience design technology evolves, so must the portal. Utah Interactive staff is skilled in understanding and implementing the latest technology to deliver a portal that meets or exceeds the latest trends in design and architecture, including web features, mobile interfaces, voice activated digital assistants, and the Internet of Things.

Health and Social Services

The first section of the Citizen Portal legislation requires that the Citizen Portal provide access to  and apply for health and social services including: 

Many of these services fall under the medicare and medicaid programs except for birth and death certificates which are managed by the Utah Department of Health.   

Medical Assistance Programs

Medical assistance is available to U.S. citizens and resident aliens who meet Utah residency and specific non-financial and financial criteria.  These programs are Medicaid, Medicare and other medical assistance program. 

 Most of these 37 assistance programs currently have an online process that has already been centralized with a custom solution built by the state called MyCase.  The state has already put significant funding over multiple years into the MyCase system to handle the complexities of these medical assistance programs.

Medicaid is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents, and women with breast or cervical cancer. To qualify, these individuals must meet eligibility requirements. Participants must meet a program type and meet the rules for Utah residency, income, and citizenship.  An individual must qualify each month for continued coverage.  

In State Fiscal Year 2017 there were 308,701 individuals participating in Medicaid each month (member months) in Utah with more than half of them being children 193,749.

Traditional Medicaid:

Members eligible for Traditional Medicaid includes:

  1. Children
  2. Pregnant Women
  3. Aged, Blind or Disabled Adults
  4. Women eligible under the Cancer Program

Some services are available only to children and to pregnant women under Traditional Medicaid. If a parent is a minor child and is the head-of-household on Family Medicaid, the minor parent will be covered by Traditional Medicaid.

Non-Traditional Medicaid:

Members eligible for Non-Traditional Medicaid includes:

  1. Adults on Family Medicaid programs (adults with dependent children)
  2. Adult care-taker relatives on Family Medicaid

Services are based on the program type a person is eligible to receive.

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.  In 2018 there were 389,765 people in Utah registered participating with Medicare out of the 3.1 million residents making up 13% of the population. https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

CHIP had 18,881 people enrolled in SFY 2017.

Applications for medicaid vary by program and sometimes are filed out by the recipient and other times are filed out by a caregiver. Some programs are for short term assistance while others provide for decades of care.

The Citizen Portal will allow for the Department of Health to define the steps in each application process, indicate if those steps are performed online or offline.  As the user progresses through the application processes, the Citizen Portal will provide them with updates as to what step has been completed along with information about the upcoming steps from articles recorded in the knowledge base.   

The following 33 Medicaid programs provided by Utah will need to be included in the Citizen Portal:

ProgramApplication
Parent/Caretaker Relative Medicaidhttps://jobs.utah.gov/mycase/
Family Medically Needy Medicaidhttps://jobs.utah.gov/mycase/
12 Month Transitional Medicaidhttps://jobs.utah.gov/mycase/
Pregnant Womanhttps://jobs.utah.gov/mycase/
Medically Needy Pregnant Womanhttps://jobs.utah.gov/mycase/
Child Under Age 1https://jobs.utah.gov/mycase/
Child Age 0-5https://jobs.utah.gov/mycase/
Child Age 6-18https://jobs.utah.gov/mycase/
Child Medically Needyhttps://jobs.utah.gov/mycase/
Refugee Medical Assistancehttps://jobs.utah.gov/mycase/
Breast and Cervical Cancer Medicaid Programhttps://jobs.utah.gov/mycase/
Foster Care Medicaid (Title IV-E)https://jobs.utah.gov/mycase/
Foster Care Medicaid (Non IV-E)https://jobs.utah.gov/mycase/
Former Foster Care Individuals (Non IV-E) and Foster Care Independent Livinghttps://jobs.utah.gov/mycase/
Custody Medical Care (MI-706)https://jobs.utah.gov/mycase/
Subsidized Adoptionshttps://jobs.utah.gov/mycase/
Baby Your Babyhttps://jobs.utah.gov/mycase/
Children’s Health Insurance Program (CHIP)https://jobs.utah.gov/mycase/
WICcall the nearest WIC clinic
PCN (Primary Care Network)https://jobs.utah.gov/mycase/
Utah’s Premium Partnership for Health Insurance (UPP)https://jobs.utah.gov/mycase/
Aged, Blind, Disabled Medicalhttps://jobs.utah.gov/mycase/
Medicaid Work Incentive (MWI) Programhttps://jobs.utah.gov/mycase/
Emergency Medicaidhttps://jobs.utah.gov/mycase/
Long Term Medicaidhttps://jobs.utah.gov/mycase/
Nursing Home (NH)https://jobs.utah.gov/mycase/
Aging Home and Community Based Waiverhttps://jobs.utah.gov/mycase/
Utah Community Supports Waiverhttps://jobs.utah.gov/mycase/
Technology Dependent Children Waiverhttps://jobs.utah.gov/mycase/
Brain Injury Waiverhttps://jobs.utah.gov/mycase/
Physical Disabilities Waiverhttps://jobs.utah.gov/mycase/
New Choices Waiverhttps://jobs.utah.gov/mycase/
Medicare Cost Sharing Programs
Qualified Medicare Beneficiaries (QMB) Programhttps://jobs.utah.gov/mycase/
Specified Low-Income Medicare Beneficiaries (SLMB) Programhttps://jobs.utah.gov/mycase/
Qualifying Individual (QI) Medicare Cost-Sharing Programhttps://jobs.utah.gov/mycase/
Other Programs
Unemployment Insurancehttps://jobs.utah.gov/ui/home/initialclaims
Workers’ compensationEmployer Company applies directly to Insurance Company

Many of these programs provide benefits directly for the person apply while the rest of the programs provide benefits for minors that may or may to be related to the person applying for the benefits.  The Citizen Portal will need to allow for notifications and status updates to be provided about children to adults that may be a foster care giver or distant relative and have temporary custody.   

The Citizen Portal will need to accommodate an adult applicant with multiple children (related and unrelated) that qualify for the different programs that may or may not live with them. Care must be taken to organize this complex information when it is displayed to the citizen.

Some services are a temporary measure while the applicant is applying for other services such as Baby Your Baby which lasts less than two months and should transition into regular Medicaid.

The Citizen Portal must carefully establish the custodial relationship of a child to the citizen before giving access to status updates within the system. Additionally, citizens may shift from one medicaid program to another when their circumstances change.

Parent/Caretaker Relative Medicaid 

Parent Caretaker Relative Medicaid provides coverage for low income parents and caretaker relatives with dependent children. Parents and caretaker relatives must meet a deprivation of support requirement. This means the children must be deprived of parental support due to the death, absence, incapacity, or underemployment of a parent or caretaker relative. Parents and caretaker relatives meet deprivation due to underemployment when the primary wage earner is unemployed or working less than 100 hours per month. Households receiving Parent/Caretaker Relative Medicaid may qualify for 12 Month Transitional Medicaid when they lose eligibility because the earned income of a parent or caretaker relative exceeds the income limit. 

Family Medically Needy Medicaid 

This program provides Medicaid coverage to low income families who do not qualify for Parent/Caretaker Relative Medicaid because of income or other household circumstances. The differences between the Parent Caretaker Relative Medicaid and the family medically needy program are that Parent Caretaker Relative Medicaid program uses tax law in the determination of income and doesn’t have an asset test. Families must include at least one eligible child in the coverage to qualify for the Medically Needy Family Program. Medically Needy Family households are not eligible for the 12 Month Transitional Medicaid program. 

12 Month Transitional Medicaid 

Parents or caretaker relatives who become ineligible for Parent/Caretaker Relative Medicaid may receive additional months of Medicaid coverage for themselves and their children depending on the reason they became ineligible. Adults who are no longer eligible for Parent/Caretaker Relative Medicaid because of increased earnings can receive up to 12 months of continuous Medicaid coverage (12 Month Transitional Medicaid). A household must meet certain income and reporting requirements to qualify for 12 Month Transitional Medicaid.

Pregnant Woman 

The Pregnant Woman program provides full Medicaid coverage to pregnant women. The program covers the mother from application through 60 days after the birth of her child. Once eligible, the woman remains eligible for the entire period. Children born to women on Medicaid in Utah can receive Medicaid through the month of their first birthday under the Child Under Age 1 program. 

Medically Needy Pregnant Woman 

This program covers pregnant women who do not meet the income limits for the Pregnant Woman program. The advantage of the Medically Needy Pregnant Woman program is that a woman may pay a spenddown and receive the coverage. The woman may receive 60 day postpartum coverage if she applies for benefits before the birth of the child. If the mother is on this program in the month of the child’s birth, the child will qualify for Medicaid for the first year under the Child Under Age 1 program with no spenddown.

Child Under Age 1 

This program covers children from birth to twelve months. Mothers who were not on Medicaid when the baby was born may apply after the birth. If the mother is determined eligible for Medicaid back to the date of the baby’s birth, the baby will receive one year of coverage. The household must provide verification of information about any possible insurance coverage for the child. Application for a Social Security card will be requested, but isn’t required. 

Child Age 0-5 

This program provides Medicaid coverage for children from birth through the month the child turns age 6. A child does not have to reside with a relative to receive coverage. 

Child Age 6-18 

This program provides Medicaid coverage for children from age 6 through the month they turn 19. A child does not have to reside with a relative to receive coverage. 

Child Medically Needy 

Children in households that do not meet the income limits for the Child Age 0-5 or Child Age 6-18 Medicaid limit may be eligible for the Child Medically Needy program. Children must be under age 18 or between age 18 and 19, in school, and expected to graduate before turning 19. Children do not have to be living with a relative. 

Refugee Medical Assistance 

Refugees entering the United States are eligible to apply for and receive Medical Assistance for 8 months after their date of entry. The same income and resource standards apply as for Family Medically Needy Medicaid. Refugee Financial Assistance automatically provides eligibility for Refugee Medical. 

Breast and Cervical Cancer Medicaid Program 

The Medicaid Cancer program provides full Medicaid benefits to uninsured individuals under age 65 who have been screened for breast or cervical cancer under the CDC (Center for Disease Control) Breast and Cervical Cancer Early Detection Program and are found to need treatment for either breast or cervical cancer, including pre-cancerous conditions and early stage cancer. An individual who is diagnosed with a precancerous condition can only receive Medicaid for three months under the Cancer program. 

Foster Care Medicaid (Title IV-E) 

The Foster Care Medicaid Program (Title IV-E) provides full Medicaid coverage to children: (1) who are in the custody of an agency within the Department of Human Services (DHS), (2) for whom a foster care maintenance payment is being made by DHS, and (3) who meet eligibility and reimbursement requirements for Title IV-E, as determined by DHS. A child may continue to qualify for this program until age 18. A child between age 18 and 19 may qualify until the month of graduation if he is attending school full time and expecting to graduate before the child’s 19th birthday. Retroactive coverage is allowed to the date of the child’s removal from the home when entering state custody. 

Foster Care Medicaid (Non IV-E) 

The Foster Care Medicaid program (Non IV-E) provides full Medicaid coverage to children: (1) who are in the custody of DHS, (2) for whom a foster care maintenance payment is being made by DHS, (3) who do not meet eligibility or reimbursement requirements for Title IV-E, as determined by DHS, and (4) who meet the requirement for another Medicaid program applicable for children. Income, assets, and other eligibility factors are as defined for other existing Medicaid programs such as Child Age 0-5, Child Age 6-18, Disabled Medicaid, or Child Medically Needy. Continuing qualification is based on the criteria for the specific program each child qualifies under. 

Former Foster Care Individuals (Non IV-E) and Foster Care Independent Living 

The Former Foster Care Individuals Medicaid program (Non IV-E) provides full Medicaid coverage to individuals: (1) are age 18 to 26, (2) were concurrently enrolled in Medicaid and Foster Care in Utah at age 18 or higher, (3) where in the custody of DCFS, DHS, or an Indian tribe when Foster Care ended. There is no income or asset limit. An extension for Medicaid coverage, called Foster Care Independent Living, is available for youth through age 21 when they age out of foster care if they receive Independent Living Services through DCFS. This is an option for former foster care youth who do not qualify for the Former Foster Care Individuals program.

Custody Medical Care (MI-706) 

The Custody Medical Care program enables children entering foster care to immediately access health care services. The program is for foster children who have not yet had Medicaid eligibility determined, who do not qualify for any Medicaid eligibility while in custody, or who need health care services not covered by Medicaid. The program is paid for with State general funds. This program has no income, asset, or deprivation tests. The program can be authorized by a DHS or a DOH Fostering Healthy Children Program Nurse for each foster child. A child may qualify for this program until state custody is discontinued. 

Subsidized Adoptions 

A subsidized adoption refers to the adoption of a child with special needs where an adoption assistance agreement is established between the adoptive parents and a state or local government agency. The adopted child may qualify for either Title IV-E or State Adoption Assistance. A child who has an adoption assistance agreement in effect with a state or local government agency is eligible to receive Medicaid. It does not matter if the child is receiving a monthly cash subsidy. There is no income or asset test for this type of Medicaid. The adoption assistance agreement usually ends the month that the child turns 18. However, the adoption assistance may extend through the month in which the child turns 21 if the child is determined to be physically, mentally or emotionally disabled by the agency originating the adoption assistance agreement. Subsidized Adoption Medicaid ends at the end of the month the adoption assistance agreement ends. 

Baby Your Baby 

Baby Your Baby is a type of temporary medical coverage for pregnant women who are determined presumptively eligible. Coverage begins the same day that a client is found eligible for the program by a qualified healthcare provider. This eligibility lasts only until the last day of the next month or until Medicaid makes a determination regarding the client’s eligibility, whichever occurs first. The woman needs to apply for regular Medicaid before the presumptive period ends. Only one Baby Your Baby Presumptive Eligibility Card can be issued per pregnancy so it is important to apply for Medicaid as soon as possible. This card covers outpatient pregnancy related services while the Medicaid application is processed. If the applicant is determined eligible for Medicaid, the Medicaid card will cover the rest of the pregnancy along with other Medicaid covered services. The infant does not qualify for the one year of coverage if the mother is only eligible under the Baby Your Baby program and does not subsequently become eligible for Medicaid. 

Children’s Health Insurance Program (CHIP) 

CHIP is a state health insurance plan for children who do not have other health insurance and do not qualify for Medicaid. Many children who qualify for CHIP come from working families. Depending on income and family size, uninsured Utah families may qualify. Once approved, CHIP covers well child exams, immunizations, dental care, hearing and eye exams, and more. 

PCN (Primary Care Network) 

PCN is a primary preventive health coverage for uninsured adults who do not qualify for Medicaid and do not have access to any other health insurance. PCN benefits include physician services, prescriptions, dental services, eye exams, emergency room visits, emergency medical transportation, birth control and general preventive services. Applications are only accepted during open enrollment periods. Age Requirement: 19 through 64 Citizenship: U.S. citizen or legal resident 

Utah’s Premium Partnership for Health Insurance (UPP) 

UPP helps uninsured, working individuals and families pay their monthly health insurance premiums. If an employee’s company offers health insurance, qualified individuals and families will receive monthly reimbursements for the cost of their employer-sponsored health insurance coverage. If qualified, UPP will pay up to $150 per adult and up to $100 per child each month. UPP is for those that do not qualify for Medicaid, have access to health insurance through their employer and have not yet enrolled in their employer-sponsored health plan. 

Aged, Blind, Disabled Medical 

This program provides Medicaid for individuals who are Aged (65+), Blind, or Disabled. People under age 65 must meet the Social Security criteria for being blind or disabled. 

Medicaid Work Incentive (MWI) Program 

MWI is a Medicaid program for persons who meet the Social Security criteria for disability and have earned income. 

Emergency Medicaid 

Emergency Medicaid is not a different Medicaid program. It refers to coverage for individuals who meet all of the other eligibility criteria for one of the Medicaid programs, but who are not U.S. citizens or qualified resident aliens. It only covers emergency medical services. Coverage is provided for the month the emergency occurs and is not provided ongoing. Pregnant women can apply one month before the expected date of delivery and receive coverage for the labor and delivery charges. Emergency Medicaid does not cover nursing home or other long-term care services, and is not available for Medicare Cost-Sharing Programs, CHIP, or PCN. An infant born to a woman eligible for Emergency Medicaid is eligible for Medicaid through the month of the baby’s first birthday.

Nursing Home (NH) 

Nursing home Medicaid will pay for nursing home and other medical costs. Some different income and asset rules apply for married couples. An individual must meet medical criteria for nursing home level of care to be 14 eligible for Medicaid in a nursing facility.

Aging Home and Community Based Waiver 

This waiver is a special program for clients who would be medically appropriate for institutional care. These clients are eligible for medical services that are not generally available to Medicaid recipients in community settings such as day treatment programs, lifeline, and in-home respite care. To be eligible for this program, recipients must be at least 65 years old. The referral process begins with the Area Agency on Aging (AAA). A case manager from AAA must complete an evaluation of the individual’s appropriateness for the waiver.

Utah Community Supports Waiver 

This waiver is a special program that helps severely disabled people of any age remain in their homes rather than be institutionalized. Applications are taken through the Division of Services for People with Disabilities (DSPD). Parent’s income and assets are not counted in determining a minor child’s eligibility. Also, an intensive service plan is drawn up for the client. To be eligible for this program, clients must have been disabled before age twenty-two. 

Technology Dependent Children Waiver 

A special program which helps medically fragile children remain in their home rather than be institutionalized. Children can qualify for this waiver through the month in which they turn 21. Recipients 21 and older who are admitted to the waiver prior to their 21st birthday may receive ongoing benefits. Applications are taken through the Division of Family Health Services. An intensive service plan is drawn up for the client and parents receive specialized training in how to provide some of the care the child needs. Families usually receive private-duty nursing services due to the complex medical condition of these children. To be eligible for this program, clients must meet specific medical criteria. 

Brain Injury Waiver 

This waiver is a special program for clients who have a brain injury and would be medically appropriate for institutional care. These clients are eligible for medical services that are not generally available to Medicaid recipients in community settings such as supported employment, day treatment programs, behavioral training, and in-home respite care. Policy follows the institutional policy except that the client is allowed higher income deductions. Applications are taken through the Division of Services for People with Disabilities (DSPD). 

Physical Disabilities Waiver 

Clients who are eligible for this waiver would be medically appropriate for institutional care. Additional services the waiver may provide include: personal care assistance, consumer training, and personal emergency response services. Policy follows the institutional policy except that the client is allowed higher income deductions. Applications are taken through the Division of Services for People with Disabilities (DSPD).

New Choices Waiver 

The New Choices Waiver provides home and community based services in community settings for eligible clients who require the level of care provided in a nursing facility. The primary goal of the NCW is to move people out of institutional care to a less restrictive community care setting. To be eligible for the NCW, an individual must be age 65 or older, or must be age 21 through 64 and meet SSA disability criteria.

Medicare Cost-Sharing Programs

SB 137 did not call out the federal Medicare programs but there is some crossover between the programs and their eligibility.  

The following information about three medicare cost sharing programs is found at the Utah Medicaid website: 

There are three Medicare cost-sharing programs for people with Part A Medicare. These programs help cover some of the member’s costs for Medicare services. They are not Medicaid programs, but a Medicaid member who has Part A Medicare may be eligible for both Medicaid and either QMB or SLMB coverage. Qualifying Individuals (QI) benefits are only available to people who are not on Medicaid. About three months after becoming eligible for a Medicare cost-sharing program, the state begins paying the Medicare Part B premium and the Social Security check will increase. 

Qualified Medicare Beneficiaries (QMB) Program

The QMB program pays Medicare premiums and copayments for low-income Medicare members. People who receive, or are eligible to receive, Part A Medicare may apply for QMB. QMB pays Medicare Part B premiums, deductibles, and Part A and Part B co-payments. It can also pay Part A premiums. Coverage begins the first of the month following the month the member is determined eligible. A Medicaid card will be issued each month. If the individual does not receive Medicaid, the card will read “MEDICARE COST-SHARING ONLY.” Otherwise, the card will look like a regular Medicaid card.

Specified Low-Income Medicare Beneficiaries (SLMB) Program

The SLMB program pays the Part B Medicare premium only. Part B Medicare covers a person’s physician care, and a variety of outpatient services including outpatient hospital services. Applicants must pass all the QMB rules, except that they must be receiving Part A coverage and their income exceeds 100% of the Federal Poverty Level and does not exceed 120% of the Federal Poverty Level. No card is issued for the SLMB program. An individual may be eligible for both Medicaid and SLMB.

Qualifying Individual (QI) Medicare Cost-Sharing Program

The QI program pays the Part B Medicare premium. Applicants must pass all the QMB rules except that they must be receiving Part A Medicare and their income exceeds 120% of the Federal Poverty Level but not more than 135% of the Federal Poverty Level and the individual cannot be receiving Medicaid. This is not an entitlement program. States have been granted a set amount of federal money to cover the benefits paid by the QI program. When funds have been allocated for a calendar year, no new applicants will receive any benefits. Eligibility in future calendar years is not guaranteed. No card is issued for the QI program.

Division of Medicaid and Health Financing

The administration of Medicaid and CHIP is accomplished through the Division Director’s office and six bureaus. Each bureau has the following responsibilities: 

Bureau Of Financial Services: The objectives and responsibilities of this bureau include monitoring, coordinating, and facilitating the Division’s efforts to operate economical and cost-effective medical assistance programs. The bureau is responsible for coordinating and monitoring federally mandated financial control systems, including monitoring of the Medicaid, CHIP, Utah’s Premium Partnership for Health Insurance (UPP), and Primary Care Network (PCN) programs. 

Bureau Of Managed Health Care: The primary responsibility of this bureau is to administer all managed care federal waivers and contracts for both Medicaid and CHIP. In addition, the bureau is responsible for staff that provide education and assistance to Medicaid and CHIP members regarding selection of managed care plans and appropriate use of Medicaid and CHIP benefits. In addition, the bureau is responsible for the early periodic screening, diagnosis, and treatment (EPSDT) program that provides well-child health care, the Medicaid restriction program, the School Based Skills Development program, and the Electronic Health Record/Health Information Technology incentive program. 

Bureau Of Authorization And Community-based Services: The general responsibilities of this bureau include policy formulation, interpretation, and implementation of quality, cost-effective long term services and supports that meet the needs and preferences of Utah’s low-income citizens. In addition, the bureau is responsible for prior authorizations of Medicaid services not provided by managed care organizations on behalf of Medicaid members. 

Bureau Of Medicaid Operations: This bureau’s main objectives are to oversee the accurate and expeditious processing of claims submitted for covered services on behalf of eligible members and the training of providers regarding allowable Medicaid expenditures and billing practices. The general responsibilities include provider enrollment, processing and adjudication of medical claims, publishing all provider manuals, and being the single point of telephone contact for information concerning member eligibility, claims processing, and general questions about the Medicaid program.

Bureau Of Coverage And Reimbursement Policy: The general responsibilities of this bureau include benefit policy formulation, interpretation, and implementation planning. This responsibility encompasses scope of service and reimbursement policy for Utah’s Medicaid program. The bureau also maintains the State Plan and oversees the pharmacy program, which includes the Drug Utilization Review Board and the Preferred Drug List. 

Bureau Of Eligibility Policy: The primary responsibility of this bureau is to oversee eligibility determinations for Medicaid and CHIP. This includes: interpreting federal or state regulations and writing medical eligibility policy, providing timely disability decisions based on Social Security Disability criteria, monitoring the accuracy and timeliness of the Medicaid program by reviewing eligibility determinations under guidance from the Centers for Medicare and Medicaid Services (CMS), purchasing private health insurance plans for Medicaid members who are at high risk (which saves Medicaid program dollars), and monitoring for program accuracy. The bureau director also serves as the state CHIP Director.

Additional Health Services Requirements

IF YOU RECEIVE MEDICAL COVERAGE BENEFITS, RESIDENTS MUST REPORT at My Case:

Changes in Marital Status, Pregnancy Status, or Living Arrangement
Getting married, separated, or divorced; moving in with a roommate; changing an address or phone number; absent parent moving in; pregnancy; birth of a baby or end of a pregnancy; household member moving in or out; death of a household member; hospital stays for more than 30 days; anyone in your household going to jail or prison; receiving help with your household expenses, etc.

Changes in Any Asset(s)
Changes in ownership or value of stocks, bonds, property, vehicles, life insurance, trust funds, burial plans, and cash, etc. for all household members; opening and closing of bank accounts. (Includes joint ownership of any asset with spouse, parents, children, etc.) (Note: This is not required for CHIP, PCN, UPP, Child or Family Medicaid unless you pay a spenddown.)

Changes in Source of Income
Getting a job, terminating a job, or working for temporary agencies; receiving educational income, SSI, SSA, or unemployment compensation, etc.; receiving a lump sum, such as SSA benefits or accident/injury awards. (Note: For CHIP and UPP, this is only required at review.) • Changes in Insurance Coverage Gaining or losing health insurance coverage or changing the health insurance premium or plan. You must also report accidents or injuries which may be payable by a third party.

Changes in Amount of Earned or Unearned Gross Monthly Income
Working more OR less hours, overtime, getting a raise, etc.; change in the amount of SSI, SSA, Unemployment Compensation, etc. (Note: For CHIP and UPP, this is only required at review.)

Changes in Expenses Paid Changes in child care expense, shelter or utility costs, or support payments.
(Note: This is not required for CHIP, PCN and UPP.)  

FOR CHILD OR FAMILY MEDICAID, CHIP, UPP, OR PCN, YOU MUST ALSO REPORT:

Changes in Tax Filing Status or Number of Dependents Claimed on Your Taxes
(Note: For CHIP and UPP, this is only required at review.)

Changes in Access to Health Insurance Coverage
Gaining access to coverage under an employer sponsored health insurance plan, COBRA, Veteran’s Administration, or Medicare. For PCN, this also includes health plans offered by a college/university. (Note: This is only required for CHIP, PCN and UPP.)

Changes in Earnings of a Child
(Note: For CHIP and UPP, this is only required at review.)

Changes in Student Status of a Child
(Note: For CHIP and UPP, this is only required at review.)

All of these changes can currently be reported at MyCase.

Workers Compensation

Workers’ Compensation Claims Process

Filing a claim for workers’ compensation benefits appears to be a very complicated process for employees whose employers may not be helpful, or who may not understand the process themselves.  The process is handled directly by the Insurance Company but there are reports submitted to the State of Utah.

Employers Purchase Industrial Insurance

Workers’ compensation insurance is an industrial insurance which every employer, with very few exceptions, is required to purchase to cover workplace injuries and illnesses for its employees.  Since the workers’ compensation program is a no-fault program, neither the employer nor the employee has to assign fault for an injury occurring in the workplace. The steps of how a worker’s claim for benefits proceeds in the system are as follows:

Benefits Step 1: Employer Files a First Report of Injury–Copy to worker

An injured worker reports the injury or illness to his/her employer immediately. If the injury or illness is beyond first-aid, the employer must report a First Report of Injury within seven days, this is done by reporting the injury to the workers’ compensation insurance carrier, who in turn electronically reports the injury to the Labor Commission. A copy of the report is to be given to the injured worker. This immediate notification allows the injured worker, employer and insurance carrier to promptly begin to have the injured worker receive the medical care needed to return to work as quickly as possible.

Benefits Step 2: Worker Sees Employer’s Designated Physician

The injured worker tells the medical provider that the injury or illness is work related.  The injured worker must be seen first by the employer’s designated physician or medical facility if the employer has chosen a physician or medical facility.  If there is no designated medical provider, or once they have seen the designated provider, the injured worker may choose to see a doctor of his/her choice. The doctor is to report the initial visit by “Physician’s Initial Report of Injury” (Form 123) of the injured worker to the Labor Commission, the insurance carrier and give a copy of the report to the injured worker.

Insurance Company opens a Claim Case

The insurance carrier will open a claim for benefits once they have received either one or both reports from the employer or doctor.  The insurance carrier is to make a determination of compensability of the injury or illness within 21 days of having received the claim for benefits and can file for an extension of a total of 45 days.

Determines Payout from Insurance Company

Compensable Claim.  If the claim is compensable, and if the doctor determines that the injured worker will lose work time, the insurance carrier is to contact the injured worker and the employer to determine the rate of weekly pay that the injured worker is to receive for the time off work.  All medical bills are to be paid by the insurance carrier or self-insured employer (an employer who is not self-insured is not allowed to pay medical bills directly). The injured worker is not to pay anything toward the medical care received. In most cases the claim for medical benefits is paid, the injured worker returns to work and the claim is ended. 

Denial of Claim

Denial of the claim.  If the insurance carrier denies that the claim is compensable, the insurance carrier is to send a denial letter to the injured worker and the Labor Commission.

Appeals

Application for Hearing.  If the claim is denied, the injured worker has the right to apply for a hearing at the Labor Commission to have an administrative law judge determine if the injured worker’s claim is compensable. While the workers’ compensation claim is being decided the injured workers’ private health insurance carrier can be required to cover his/her medical expenses. On the application for hearing form, Item 8 Coordination of Benefits with Your Private Health Insurance Company, must be completely filled out in order for this process to start. Please note, the injured worker is responsible for any co-pays or deductibles normally due under the private health insurance plan. The private health insurance carrier is not obligated to cover medical expenses until notice is given. For more information regarding the Utah Coordination of Benefits Act (Utah Code Ann. §31A-22-619.6, please see the Utah Labor Commission Adjudication website.

Workers’ Compensation Coordination of Benefits Untimely Payment

If an application for hearing was submitted with item 8 Coordination of Benefits with Your Private Health Insurance Company completely filled out, and the Adjudication Division determined the injury to be compensable under workers’ compensation, if the workers’ compensation carrier fails to make payment within the time frame ordered the Workers’ Compensation Coordination of Benefits Untimely Payment Complaint Form should be submitted to the Industrial Accidents Division for review.

Labor Commission Assistance.

The Industrial Accidents Division has several intake staff, ombudspersons, and mediators to help claimants resolve claims without the need for a formal hearing.  However, if the claimant has filed for a hearing, the case continues in the adjudication process until the case is either settled or heard by an administrative law judge.  For assistance, an injured worker, employer, medical provider or insurance carrier may contact the Industrial Accidents Division at 801-530-6800 or toll free (in Utah) at 1-800-530-5090.

Local Agencies

During a second phase of the Citizen Portal Utah will develop a process for filing and registrations. DTS will create a secure, centralized single sign-on Citizen Portal that individuals may perform filings and registrations with with state and local agencies including: 

Develop the single sign-on Citizen Portal using an open platform that:

Consultation with Agencies

DTS will coordinate multiple meetings to individually discuss the Citizen Portal concept to the Executive Directors as well as key managers.  These individual meetings will allow agency Directors to focus on their needs and speak freely.  

DTS will meet in 2019 with the following agencies/groups:

The objectives for these meetings will be to: 

System Design

DTS will combine the feedback received in Phase 1 with the following conceptual design. The output of this phase will have documents that describe the system APIs with detailed specifications.  The system design should be a collection of the following components: 

Transcripts From Utah Higher Education

A transcript is a record of a person’s academic progress, including transfer courses, credits earned by exam, and earned degrees.  

The Citizen Portal will store unofficial, personal copies of higher education transcripts.  Each University has their own internal system for providing transcripts. The Citizen Portal will need to connect to each institution to receive transcripts.

Utah’s Higher Education System:

Utah’s Technical Colleges

The portal will allow a student to request that official copies of transcripts are submitted to:

Currently, official digital copies of transcripts are transmitted by a central clearinghouse company called National Student Clearinghouse.  

Colleges and universities that are owed money by a former student may “hold” the transcript until they are paid. This may mean that former student cannot resume their education elsewhere.  National Student Clearinghouse will collect outstanding debts for Utah Higher Education at the time the transcripts are requested.

Citizen Portal Schedule

ServiceStartComplete
Transaction ManagerQ2 2020Q4 2020
Notification ServiceQ2 2020Q3 2020
Help DeskQ2 2020Q4 2020
Knowledge BaseQ2 2020Q4 2020
Citizen Portal DashboardQ4 2020Q2 2021
Citizen Portal Agency DashboardQ4 2020Q1 2021
Mobile DashboardQ4 2020Q3 2021
Mobile Driver License (mDL)Q1 2021Q3 2021
Digital Wallet (Professional Licenses, Hunting & Fishing, …)Q4 2021Q4 2022
Transaction Recommendation ServiceQ4 2020Q3 2021