PCN Enrollment Update

After adding 10,000 recipients in four months, PCN is now closed to childless adults.

Utah’s Primary Care Network (PCN) is closed to childless adults after four months of steady enrollment. Adults and caretakers with dependent children are still able to apply. Because PCN is a capped enrollment program, adults without dependent children won’t be able to sign up u

ntil further notice. The Department of Workforce Services (DWS) reported over 400 adults without children have been denied coverage under the program since the cap went into effect on October 1st. However, some of these individuals may not have been eligible for PCN.

PCN began accepting new applicants in early June. Since then, over 10,000 Utah adults have successfully enrolled. All of them earn below 100% of the federal poverty level (FPL) and are ineligible for both subsidized private insurance on healthcare.gov or current Utah Medicaid.

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. 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 on a case-by-case basis.

Currently, PCN has funding and federal approval to remain operational through December 31st, 2014. The Department of Health has submitted an extension request to Health and Human Services Secretary Burwell, but the fate of the program will likely depend on whether Utah lawmakers pass the Governor’s Healthy Utah Plan.

Receiving PCN is a temporary solution for the 45,000 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.” If the state enacts Gov. Herbert’s Healthy Utah Plan, current PCN recipients would transition to subsidized private insurance offered by that plan.