After years of debate over how to administer Medicaid in Utah, the state has moved to a fully-expanded the program for low-income residents beginning Wednesday, guaranteeing access to health care for tens of thousands of people.

The move to full expansion means that anyone earning less than 138% of the federal poverty level — roughly $35,000 for a family of four or $17,000 for an individual — is now eligible for Medicaid services. Individuals interested in checking their eligibility or applying for Medicaid can do so by visiting the offices of the Division of Workforce Services or by completing an online application at medicaid.utah.gov.

“This is a proud moment for Utah,” Matt Slonaker, executive director of the Utah Health Policy Project, said in a prepared statement. “Full expansion goes live January 1st, 2020.”

Wednesday’s rollout follows the rejection of a partial expansion program approved by lawmakers in February, which itself replaced the voter-approved Proposition 3, which sought full expansion for the state.

But while the state now covers the same low-income population as Proposition 3, Wednesday’s expansion requires beneficiaries to comply with work requirements in order to maintain their eligibility.

Slonaker said this expansion has arrived later than — and with different requirements from how — advocates hoped it would. But he described the change as “transformative."

“The work search requirement complicates things,” Slonaker said, “but don’t let that deter you from enrolling.”

Kolbi Young, a Utah Medicaid spokeswoman, said roughly 120,000 Utahns are estimated to qualify for Medicaid under full expansion. Among that group, roughly 40,000 have already enrolled under the state’s previous, partial expansion plan.

Earlier estimates suggested full expansion would cover up to 150,000 Utahns, but that number includes the so-called “woodwork effect," in which individuals who are already eligible for Medicaid might be motivated to enroll by the community attention around those newly eligible.

“We’ve had expansion efforts in the past, but they have not gone up to the 138 [percent of poverty level],” Young said. “I think that has been a source of confusion for individuals not knowing exactly what Utah’s expansion program looks like.”

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She said many low-income Utahns will qualify for exemptions from the work requirements — including those older than 60, students and parents of young children. Those who are not exempt will be required to complete online job assessments and training through the Division of Workforce Services, she said, and document 48 job searches during their first three months of eligibility.

That work search requirement renews each year, she said, but beneficiaries are not penalized for failing to obtain work.