Utah Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: March 07, 2024


Utah Medicaid Long-Term Care Definition

Medicaid is a health insurance program for low-income individuals of all ages. While health coverage is available for diverse groups of persons, this page is focused on long-term care Medicaid eligibility for Utah senior residents, aged 65 and over. In addition to care services in nursing homes, adult foster care homes, and assisted living facilities, UT Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who meets the eligibility requirements will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; there are participant caps for enrollment and waiting lists may exist. Intended to delay nursing home admissions, benefits are provided at home, adult day care, adult foster care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged, Blind or Disabled (ABD) – An entitlement; anyone who meets the eligibility requirements will receive assistance. Various long-term care services, such as personal care assistance or adult day care, may be available.

While Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. In Utah, the administering agency is the Utah Department of Health & Human Services. Eligibility is determined by the Department of Workforce Services (DWS).

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.


Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical eligibility criteria. Further complicating financial eligibility is that the requirements change annually, vary with marital status, and that Utah offers multiple pathways towards Medicaid eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
Utah seniors must be financially and medically eligible to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) While there is no income limit, nearly all of one’s income must be paid toward nursing home care 2) Assets under $2,000 3) Require a Nursing Home Level of Care.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Utah Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Utah. More.

2024 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* $2,000 Nursing Home No income limit* $4,000 ($2,000 per spouse) Nursing Home No income limit* $2,000 for applicant & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services Aging Waiver ($1,255 / month – eff. 3/1/24 – 2/28/25)
New Choices Waiver ($2,829 / month – eff. 1/1/24 – 12/31/24)†
$2,000 Nursing Home Aging Waiver ($1,255 / month per spouse – eff. 3/1/24 – 2/28/25)
New Choices Waiver ($2,829 / month per spouse – eff. 1/1/24- 12/31/24)†
$4,000 ($2,000 per spouse) Nursing Home Aging Waiver ($1,255 / month for applicant – eff. 3/1/24 – 2/28/25)
New Choices Waiver ($2,829 / month for applicant– eff. 1/1/24 – 12/31/24)†
$2,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind or Disabled $1,255 / month (eff 3/1/24 – 2/28/25) $2,000 Help with ADLs $1,703 / month (eff. 3/1/24 – 2/28/25) $3,000 Help with ADLs $1,703 / month (eff. 3/1/24 – 2/28/25) $3,000 Help with ADLs
*With the exception of a Personal Needs Allowance of $45 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, all of a beneficiary’s monthly income must go to the nursing home. This is called a Patient Liability.

Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.


Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in UT, the VA Aid & Attendance or Housebound Allowance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When just one spouse of a married couple applies for Nursing Nome Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted towards Medicaid’s asset limit. This means that regardless of the amount of monthly income a non-applicant spouse receives, it does not impact the income eligibility of their applicant spouse. The non-applicant spouse, however, might be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their spouse.

The MMMNA is a Spousal Impoverishment Rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid poverty. The MMMNA in UT is $2,465 (eff. 7/1/23 – 6/30/24). If a non-applicant’s monthly income is under $2,465, income can be transferred to them from their applicant spouse, bringing their income up to this level. In Utah, a non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $740 / month (eff. 7/1/23 – 6/30/24). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s total income over $3,854 / month. This is the Maximum Monthly Maintenance Needs Allowance. More on how the Spousal Allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind or Disabled; the income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.


Asset Definition & Exceptions

Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, promissory notes, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Utah, IRA’s / 401K’s are also counted. There are also many assets that Medicaid does not count; they are exempt. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, irrevocable burial trusts up to $7,000, life insurance with a combined face value up to $1,500, and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. However, the non-applicant spouse of a Medicaid nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). This is a Spousal Impoverishment Provision.

In 2024, the CSRA allows the community spouse (the non-applicant spouse) to retain 50% of the couple’s assets, up to a maximum of $154,140. If the non-applicant’s portion is under $30,828, 100% of the assets, up to $30,828 can be retained by the non-applicant. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Utah has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Nursing Home Medicaid or Medicaid Waiver application date. During the “look back”, Medicaid checks all past asset transfers, including ones made by a non-applicant spouse, to ensure no assets were gifted or sold under fair market value. If this has been done, it is assumed it was done to meet Medicaid’s asset limit, and a Penalty Period of Medicaid ineligibility will be calculated. There is no Look-Back Period for Regular Medicaid.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.


Utah Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live in it, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Utah’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.


Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NHLOC) is required. Furthermore, some program benefits may require additional eligibility criteria be met. As an example, for home modifications, an inability to safely live at home without modifying the home may be necessary. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.


Qualifying When Over the Limits

For Utah elderly residents (aged 65 and over) who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Also called a Spenddown Program in Utah, this pathway allows seniors who would otherwise be over Medicaid’s income limit to become income-eligible if they have high medical expenses. Effective 3/1/24 – 2/28/25, the Medically Needy Income Limit (MNIL) in UT is $1,255 / month for a single applicant and $1,703 / month for a couple. The “spend-down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. Persons can meet their “spend down” by paying overdue medical bills, prescription drugs, private health insurance, and medical expenses not covered by Medicaid. Persons may also pay their spend down amount directly to the state of Utah. Once the “spend down” is met, one will be income-eligible for the remainder of the month. The Medically Needy Asset Limit is $2,000 for an individual and $3,000 for a couple.

2) Asset Spend Down – Persons who have countable assets over Medicaid’s limit can “spend down” excess assets on non-countable ones and become asset-eligible. Examples include home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s Look-Back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

 Our Spend Down Calculator can assist UT seniors in determining if they might have a Spend Down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their cost of long-term care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible as well as to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.


Specific Utah Medicaid Programs

In addition to paying for nursing home care, Utah Medicaid offers the following programs relevant to the elderly that helps them to remain living at home and in the community.

1) State Plan Personal Care Services – Assistance with daily living activities is provided via the state’s Regular Medicaid plan to promote independent living and prevent nursing home admissions. Benefits include aid with mobility, preparation of meals, bathing, grooming, and toiletry.

2) Aging Waiver for Individuals Age 65 or Older – 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) Medicaid New Choices Waiver (NCW) – This Medicaid Waiver assists seniors and individuals with disabilities who currently live in an assisted living facility or nursing home to transition back to living in one’s home, the home of a relative, or another community based residence that allows one to live more independently. 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.


How to Apply for Utah Medicaid

Senior residents can apply for Medicaid in Utah online at myCase, download and submit a completed paper application (towards the bottom of the webpage), or apply in person at their local Department of Workforce Services (DWS) office. For questions or assistance, seniors can also contact DWS at 866-435-7414. Persons might also find their local Area Agency on Aging office helpful. The application process may vary based on the program for which one is applying.

Prior to submitting an application for Medicaid benefits in Utah, seniors need be certain that all eligibility requirements (as discussed above) for the program for which they are applying are met. Being over the income and / or asset limit(s), or being uncertain if eligibility criteria are met, can result in a denial of benefits. Persons in these situations should seriously consider Medicaid planning. Familiarizing oneself with general information about the long-term care Medicaid application process can be helpful.

Determine Your Medicaid Eligibility

Get Help Qualifying for Medicaid