Utah ranked lowest among Medicaid expansion states for public health insurance coverage of low-income children in 2021


Boram Kim


Recent data from the US Census Bureau’s American Community Survey show that 84% of low-income children who qualified for Medicaid in 2021 in Utah were not enrolled. That is the highest rate in the country among the 36 states that have expanded Medicaid. It’s also higher than Wyoming, which is a non-expansion state with more severe income restrictions.


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Utah also had the 3rd highest rate of children from low-income families who are uninsured at 15% or 42,000 kids. 

“Utah has one of the highest rates of children who are eligible for coverage but not enrolled in the United States,” said Emily Zheutlin, Health Policy Analyst at the Utah Health Policy Project.

“Unfortunately, this has been true for many years, even before the pandemic. Much more work needs to be done to advocate for these children and it’s time for Utah’s legislature to take action. The 2023 session will be pivotal in achieving 100% kids covered in Utah. Study after study show health care coverage for kids not only improves children’s health, but also promotes higher academic achievement, overall wellbeing, and many other life-long benefits.” 

Meanwhile, Utah has the highest rate (77.8%) of private insurance coverage among expansion states with insurance premiums much lower than the national average. 

According to the Bureau of Labor Statistics, Utah’s unemployment rate (2.7%) was much lower than the national average. The comprehensive health insurance premium per member per month in Utah was also lower than the national average at $386 in 2020, according to the state’s last health insurance market report. The Census Bureau attributed Utah’s high rate of employer-sponsored coverage to strong economic conditions.

As of January 2022, Medicaid enrollment in Utah has grown by 114,199 enrollees, with 31,025 of those adult enrollments being parents. 

The higher enrollment is due in large part to the continuous coverage provision of the Families First Coronavirus Response Act, which prohibits state Medicaid agencies from disenrolling beneficiaries during the public health emergency (PHE). 

President Biden recently declared an end to the pandemic and his administration has signaled that PHE relief will remain in place until January 2023. 

Voices for Utah Children, a local non-profit advocating health coverage for all children in the state, has called on Utah’s Medicaid program to adopt a policy of 12-month continuous coverage. 

“Utah’s child insurance rankings underscore why it is so critical we adopt state policies to assure all kids are connected with consistent health coverage,” the organization said in a statement.

“We have been monitoring the consistent decline and low coverage rates for years. We must pass policies that ensure all Utah kids have access to CHIP and Medicaid, and that we adopt 12-month continuous coverage. These policies can help us decrease Utah’s high uninsured rate and help avoid further coverage loss and disruptions when the Public Health Emergency ends. We can take these proactive measures to get Utah kids’ coverage back on track, so that all Utah kids can get the coverage and care they need to thrive.”

The organization has called on the state to conduct better outreach and enrollment assistance programs so that families can better access coverage that meets their specific needs. 

Of the children expected to lose Medicaid coverage nationwide once PHE provisions end, the Urban Institute estimates 57% would be eligible for the Children’s Health Insurance Program , and another 9% percent would be eligible for Marketplace coverage with tax credits. 

One-third of people who stand to lose Medicaid coverage after the end of the PHE could qualify for other sources of subsidized private health coverage in the Marketplaces in the form of premium tax credits that could be made available to the families if the enhanced tax credits in the American Rescue Plan Act are made permanent. 

The institute cited the need for good coordination between the Marketplace and the Medicaid agency in each state to reduce unnecessary losses of health coverage when the PHE ends.