Utah Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Utah, Medicaid eligibility is determined by the Department of Workforce Services. This article focuses on Utah Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jan 02, 2024

Utah Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Utah Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Utah Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Utah residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Utah Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $45/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Home and Community Based Services (HCBS) Waivers

Utah’s Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Utah seniors who require a Nursing Facility Level of Care remain, or return to, living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Utah residents who live in their own home, the home of a loved one, an assisted living residence, a small health care facilities or a community residential treatment center. While Utah HCBS Waivers may cover some long-term care services and supports in those settings, they will not cover room and board costs.

The HCBS Waivers relevant to Utah seniors are the Aging Waiver for Individuals Age 65 or Older and the New Choices Waiver (NCW).

1. Aging Waiver for Individuals Age 65 or Older
Utah’s Aging Waiver for Individuals Age 65 or Older (which is also called the Aging Waiver) provides long-term care services and supports to Utah seniors who require a Nursing Facility Level of Care but live in their own home or the home of a loved one. Available benefits include adult day care, home modifications, homemaker services, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits will be provided depending on the needs and circumstances of each applicant.

Aging Waiver benefits can be delivered by an agency provider, but program participants also have the option to self-direct their care by hiring friends and family members (even spouses in some cases) to provide some of their services. A financial services agency handles some of the responsibilities of employment for the Aging Waiver beneficiary, such as payments, tax withholding and background checks.

Unlike Nursing Home Medicaid, most HCBS Waivers are not an entitlement. Instead, they have a limited number of enrollment spots, and once those spots are full additional applicants are placed on a waitlist. Utah’s Aging Waiver had 550 enrollment spots as of 2023. Once those spots are full, additional eligible applicants will be placed on a waitlist.

2. New Choices Waiver
Utah’s New Choices Waiver (NCW) helps Utah Medicaid beneficiaries who require a Nursing Facility Level of Care and live in a nursing home, assisted living residence, medical institution (not a mental health facility) or small health care facility (Type N) move to a community-based residence. These can include their own home, the home of a loved one, adult foster care, communal residential treatment facilities, independent living facilities, assisted living residences, small health care facilities and memory care units specializing in Alzheimer’s disease and related dementias. While the NCW will help cover the costs of moving into those settings and will provide long-term care services there as well, it will not cover room and board costs.

In order for an applicant to be eligible for the New Choices Waiver, one of the following must apply:

They live in a Medicaid-funded nursing home and have been there for at least 90 days.
They live in and have been receiving Medicare-funded care in a medical facility (not an institution for mental disease) for at least 30 days, and they will be discharged to a Medicaid-funded nursing home for a minimum of 60 days.
They live in an assisted living residence and have been there for at least 365 days.
They live in a small health care facility (Type N) and have been there for at least 365 days.

New Choices Waiver (NCW) benefits are provided depending on each individual’s needs and circumstances. They can include covering transition expenses (such as paying for movers, security deposits and basic furnishings), as well as long-term care services like adult day care, meal delivery, home modifications, homemaker services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits can be delivered by an agency provider, but NCW beneficiaries also have the option to self-direct their care by hiring caregivers of their choice, including family members, friends and in some cases spouses. A financial services agency handles some of the responsibilities of employment for the NCW beneficiary, such as payments, tax withholding and background checks.

Utah’s New Choices Waiver is not an entitlement. Instead, it has a limited number of enrollment spots (approximately 2,500 as of 202s). Once those spots are full, additional applicants will be placed on a waitlist.

Aged, Blind, and Disabled (ABD) Medicaid

Utah’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Utah residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

Utah ABD Medicaid beneficiaries receive their long-term care benefits through the State Plan Personal Care Services program.

State Plan Personal Care Services
To be eligible for Utah’s State Plan Personal Care Services program, the applicant’s physician must acknowledge the applicant needs personal care help, the applicant must not be be bedbound (unable to leave their bed), and the applicant must need help with at least two of the following activities:

Toileting
Bathing
Skin care
Mobility (including with canes, walkers, wheelchairs)
Grooming (dressing, shaving, hair care, etc.)
Meals (planning, shopping, cooking, cleaning)
Medication management

Benefits of the State Plan Personal Care Services Program include transportation, basic foot care, basic tooth/denture care, hep with household tasks, help with meals (planning, shopping, cooking, cleaning) and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

Like ABD Medicaid itself, Utah’s State Plan Personal Care Services Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages and benefits into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Utah does not have a PACE program of its own as of Jan. 1, 2024, there are programs in neighboring Colorado and New Mexico. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

Eligibility Criteria For Utah Medicaid Long Term Care Programs

To be eligible for Utah Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current Utah Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Utah Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Utah residents have to meet an asset limit in order to be financially eligible for nursing home coverage through Utah Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Utah Medicaid is a combined $4,000. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance.

There is no income limit for nursing home coverage through Utah Medicaid, However, Utah Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $45/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

Plan Ahead: There are alternative pathways to eligibility for Utah Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Utah has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Utah Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. An applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), is used to determine if a Nursing Facility Level of Care is needed. Utah uses the interRAI Minimum Data Set – Home Care (MDS-HC) assessment tool to determine level of care requirements for Medicaid purposes.

Utah Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Utah residents have to meet an an asset limit and an income limit in order to be financially eligible for the state’s Home and Community Based Service (HCBS) Waivers – the Aging Waiver for Individuals Age 65 or Older and the New Choices Waiver (NCW) – although the limits are different for the two Waivers.

The asset limit for Utah’s Aging Waiver for Individuals Age 65 or Older for a single applicant from March 2023 to Feb. 2024 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The individual income limit for the Aging Waiver from March 2023 to Feb. 2024 is $1,215/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying for the Aging Waiver, the asset limit from March 2023 to Feb. 2024 is a combined $4,000, and the income limit is $1,643/month per spouse. For a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,215/month for the applicant, and the income of the non-applicant spouse is not counted.

For a single applicant in 2024, the asset limit for Utah’s New Choices Waiver (NCW) is $2,000 and the income limit is $2,829/month. For married applicants with both spouses applying for the NCW, the 2024 asset limit is a combined $4,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Utah HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Utah has a Look-Back Period of five years. This means the state will look back into the previous five years of the HCBS Waiver applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Utah Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. An applicant’s ability to to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.), is used to determine if a Nursing Facility Level of Care is needed. Utah uses the interRAI Minimum Data Set – Home Care (MDS-HC) assessment tool to determine if HCBS Waiver applicants do require a Nursing Facility Level of Care.

Utah Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Utah residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. The asset limit for a single applicant from March 2024 to Feb. 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for Utah ABD Medicaid for a single applicant from March 2024 to Feb. 2025 is $1,255/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the asset limit for Utah’s ABD Medicaid is a combined $3,000 combined, and the income limit is a combined $1,703/month from March 2024 to Feb. 2025. This applies to married couples with both spouses applying or with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Utah ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Utah has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Utah ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Utah Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Utah Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Utah and how you can protect your home from it, click here.

Applying For Utah Medicaid Long Term Care Programs

The first step in applying for Utah Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Utah Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Utah Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Utah residents can apply online at myCase. They can also download an application here (the form is about halfway down the webpage) and then return it to their local Department of Workforce Services (DWS) office.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Utah Medicaid Nursing Home

After being approved for nursing home coverage through Utah Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available space. Finding the right residence can be difficult, especially if you’re looking in a specific location.

Utah has about 80 nursing homes that accept Medicaid. There are roughly 30 facilities within 10 miles of Salt Lake City, and a dozen or so in the Ogden area. Provo has eight nursing homes that take Medicaid. And there are eight facilities within 25 miles of St. George in the southwest corner of the state. The choices narrow outside of those cities and most communities have just one facility.

TOOLS: Utah residents can find and compare nursing homes using Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. This Utah Eldercare Planning Council webpage has its own list of Utah nursing homes to help in the search.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in Utah.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data collected from 2019-2022 shows the nursing homes in Utah are on par with the national averages when it comes to health standards, fire safety, resident-to-staff ratio and resident well-being.