Ed. Note: This article is corrected in several places since its original publication. Thanks to the Dept. of Health (DOH) for alerting us to these changes. We regret any inconvenience caused by the errors. UHPP will provide additional PCN updates in May and June.
If you don’t qualify for Medicaid in Utah, the state’s Primary Care Network (PCN) is your next-best option for basic health coverage. UHPP has learned that several thousand PCN spots (ed. DOH reports it will be more than 3,000, but no specific number is available) will become available on June 2. Adults with and without dependent children can apply. Utah’s DOH has not indicated a closing date for this upcoming open enrollment period.
PCN enrollment is opened on an annual basis, but extra spots were created this year by transitioning recipients who earn over 100% of the federal poverty level (FPL) to subsidized private insurance on healthcare.gov. Once open enrollment for PCN begins, eligible Utahns can apply here.
PCN began in 2002 as a Medicaid waiver program to offer limited coverage to low income parents or adults without children who didn’t qualify for traditional Medicaid. Enrollment is currently limited to 18,000 to 19,000 adults because of available funding, but 2013 monthly enrollment averaged 13,904 (pdf, page 29). Utah’s waiver allows up to 25,000 participants, but the actual number is subject to funding levels. Currently, PCN has federal approval to remain operational through December 31st, 2014. The fate of the program after 2014 is not known.
Applications for the program will be available through the website, www.health.utah.pcn.
Receiving PCN could be a temporary solution for the 57,000 Utahns who earn too little to buy subsidized insurance on healthcare.gov, but earn too much to qualify for Medicaid. These Utahns earning under 100% FPL fall into our state’s “coverage gap.”
However, PCN is not comprehensive health insurance. It offers limited prevention-oriented health coverage, which includes primary-care doctor visits, up to four prescriptions per month, dental and vision care, immunizations and other services. PCN does not cover inpatient hospital care, mental health services, or specialty care—even with a primary care doctor’s referral. PCN covers emergency room visits if and when the final diagnosis is an approved medical emergency. The last enrollment period for PCN occurred in April 2013 and lasted for two weeks.
Recent Changes to Utah’s Primary Care Network (PCN)
-Open enrollment begins June 2, 2014. Eligible Utahns can apply here.
-Open to uninsured adults earning below 100% FPL (under $11,490 for a single adult, and $15,510 for two adults) [See the 2013 Federal Poverty Level Chart here]
-No annual enrollment fee
-MAGI income and household income rules apply
-Eligibility determinations will still be made annually. Enrollees will not have to have their eligibility confirmed every month.
-CORRECTED: Even though PCN is not “minimum essential coverage,” losing it DOES qualify as a special enrollment period to purchase subsidized insurance on healthcare.gov. This is due to a negotiation between Utah and HHS for the waiver extension.
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