H.B. 37 Enrolled

RESTRUCTURE SPEND DOWN PROVISION FOR
MEDICAID
2003 GENERAL SESSION
STATE OF UTAH
Sponsor: Rebecca D. Lockhart
This act modifies the Medical Assistance Act. The act restores Medicaid eligibility to an
aged, blind, or disabled person below 100% of the federal poverty level. The act defines
terms and directs the Health Department to use 100% of the federal poverty level as the
income standard when determining if the aged, blind, or disabled have spent down
enough excess income to be eligible for Medicaid benefits.
This act affects sections of Utah Code Annotated 1953 as follows:
AMENDS:
26-18-3, as last amended by Chapter 316, Laws of Utah 2000
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 26-18-3 is amended to read:
26-18-3. Administration of Medicaid program by department -- Disciplinary
measures and sanctions -- Funds collected.
(1) The department shall be the single state agency responsible for the administration
of the Medicaid program in connection with the United States Department of Health and
Human Services pursuant to Title XIX of the Social Security Act.
(2) The department shall develop implementing policy in conformity with this chapter,
the requirements of Title XIX, and applicable federal regulations.
(3) The department may, in its discretion, contract with the Department of Human
Services or other qualified agencies for services in connection with the administration of the
Medicaid program, including but not limited to the determination of the eligibility of
individuals for the program, recovery of overpayments, and enforcement of fraud and abuse
laws, consistent with Section 26-20-13 , to the extent permitted by law and quality control
services.
(4) The department shall provide, by rule, disciplinary measures and sanctions for

Medicaid providers who fail to comply with the rules and procedures of the program, provided
that sanctions imposed administratively may not extend beyond:
(a) termination from the program;
(b) recovery of claim reimbursements incorrectly paid; and
(c) those specified in Section 1919 of Title XIX of the federal Social Security Act.
(5) Funds collected as a result of a sanction imposed under Section 1919 of Title XIX of
the federal Social Security Act shall be deposited in the General Fund as nonlapsing dedicated
credits to be used by the division in accordance with the requirements of that section.
(6) (a) In determining whether an applicant or recipient is eligible for a service or benefit
under this part or Chapter 40, Utah Children's Health Insurance [Program] Act, the department
shall, if Subsection (6)(b) is satisfied, exclude from consideration one passenger vehicle
designated by the applicant or recipient.
(b) Before Subsection (6)(a) may be applied:
(i) the federal government must:
(A) determine that Subsection (6)(a) may be implemented within the state's existing
public assistance-related waivers as of January 1, 1999;
(B) extend a waiver to the state permitting the implementation of Subsection (6)(a); or
(C) determine that the state's waivers that permit dual eligibility determinations for cash
assistance and Medicaid are no longer valid; and
(ii) the department must determine that Subsection (6)(a) can be implemented within
existing funding.
(7) (a) For purposes of this Subsection (7):
(i) "aged, blind, or disabled" shall be defined by administrative rule; and
(ii) "spend down" means an amount of income in excess of the allowable income
standard that must be paid in cash to the department or incurred through the medical services not
paid by Medicaid.
(b) In determining whether an applicant or recipient who is aged, blind, or disabled is
eligible for a service or benefit under this chapter, the department shall use 100% of the federal

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poverty level as:
(i) the allowable income standard for eligibility for services or benefits; and
(ii) the allowable income standard for eligibility as a result of spend down.

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