Utah Medicaid Definition
In Utah, the agency that administers the Medicaid program is the Utah Department of Health.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Utah residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, this page is focused strictly on Medicaid eligibility for Utah elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Utah seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Utah offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program for assistance only in nursing home facilities. Anyone who meets the eligibility requirements will receive assistance.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are participant caps for enrollment. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged and Disabled – this is an entitlement program for assistance at home or adult day care. Anyone who meets the eligibility requirements will receive assistance.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Utah Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Utah Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||No income limit. One’s monthly income determines how much one must pay towards the cost of care.||$2,000||Nursing Home||No income limit. Each spouse’s monthly income determines how much each spouse must pay towards the cost of care.||$4,000 (Each spouse can have up to $2,000)||Nursing Home||No income limit. One’s monthly income determines how much one must pay towards the cost of care.||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||Aging Waiver ($1,012 / month) New Choices Waiver ($2,250 / month)||$2,000||Nursing Home||Aging Waiver (Each spouse is allowed up to $1,012 / month) New Choices Waiver (Each spouse is allowed up to $2,250 / month)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||Aging Waiver ($1,012 / month for applicant) New Choices Waiver ($2,250 / month for applicant)||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$2,000||None||$1,372/ month||$3,000||None||$1,012 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse does not affect the eligibility of the applicant spouse regardless of how much income the non-applicant spouse receives each month. For married couples, with non-applicant spouses’ with insufficient income in which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses have sufficient income in which to live. Basically, if the non-applicant spouse, who is also called a community spouse or well spouse, has income under $2,057.50 / month, as of 7/1/18 (this figure changes each year in July), he or she is entitled to a portion of the applicant spouse’s income (to bring the non-applicant spouse’s income to $2,057.50 / month). Based on one’s shelter and utility costs, an applicant spouse may be entitled to an even greater amount, up to $3,090 / month. (This figure changes January 1st of each year.)
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, irrevocable funeral trusts, and life insurance with a combined face value up to $1,500. One’s primary home, given the Medicaid applicant or their spouse lives in it and the equity value is under $572,000 (in 2018) is also exempt. For single Medicaid applicants that do not live in their homes, but intend to return to them, their homes are also exempt as long as the equity value is not greater than the above-mentioned $572,000. For married couples, as of 2018, the community spouse can retain half of the couples’ joint assets (up to a maximum of $123,600), as shown in the chart above. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Utah has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers, including one’s made by a non-applicant spouse, to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For Utah elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Utah, the Medically Needy Pathway, also called a Spenddown Program, allows seniors who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” their income to the Medicaid income limit. This can be done by paying excess income to the state of Utah or paying a provider for medical services / goods. This may include paying unpaid medical bills, prescription drugs, private health insurance, and medical expenses that Medicaid does not cover. Once one has spent their income down to the income limit, Medicaid will kick in for the remainder of the spenddown period, which is one month in Utah.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones. Examples include home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. When spending down assets, it’s important that one does not give away assets or sell them for less than their value. This is because in Utah, as mentioned previously, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility will result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Utah Medicaid Programs
1) Utah State Plan Personal Care Services – assistance with daily living activities is provided via the state Medicaid plan (available to anyone who meets the eligibility requirements) to promote independent living and prevent nursing home admissions. Benefits include aid with mobility, preparation of meals, bathing and grooming, and toiletry.
2) Utah Aging Waiver for Individuals Age 65 or Older – also referred to as the Aging Waiver, this home and community based services Medicaid waiver allows program participants to hire the caregiver of their choosing, including some relatives. Other benefits include adult day care, homemaker services, meal delivery, home modifications and more.
3) Utah Medicaid New Choices Waiver (NCW) – this Medicaid waiver assists seniors and disabled individuals who currently live in an assisted living facility or nursing home to transition back to living in one’s home or the home of a relative. In addition to transitional services, other benefits include durable medical equipment, assistive technology, respite care, and personal emergency response systems. This program also allows for self-direction of care services.