Utah Primary Care Network

Utah's Primary Care Network (PCN) is a statewide section 1115 Demonstration that provides expanded access to Medicaid funded health care coverage, and additional options to provide premium assistance for employer-sponsored insurance (ESI) or COBRA continuation coverage. Through the demonstration, up to 25,000 uninsured adults age 19 and older with incomes up to 150% FPL may receive the PCN benefit, which includes coverage for a limited package of preventive and primary care services (i.e., no inpatient hospital coverage). Savings to fund the coverage expansion are generated by providing a reduced Medicaid benefits package and increased cost-sharing to certain able-bodied State plan eligibles who are categorically or medically needy parents or other caretaker relatives. Persons eligible for the PCN benefit with access to employer-sponsored health insurance (ESI) or COBRA continuation coverage may elect instead to receive premium assistance toward the purchase of that coverage. Children who are eligible for the State's CHIP program and who have access to ESI or COBRA also may elect premium assistance in lieu of CHIP coverage. Finally, high risk pregnant women, whose resources made them ineligible under the State plan, are covered under the Demonstration for the full Medicaid benefits package.