Utah Medicaid Definition
In Utah, the agency that administers the Medicaid program is the Utah Department of Health. Eligibility is determined by the Department of Workforce Services (DWS).
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 might be immediately eligible for long term care from an Utah Medicaid program. Alternatively, one may opt to take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Utah. More.
|2020 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 & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||Aging Waiver ($1,063 / month) New Choices Waiver ($2,349 / month)||$2,000||Nursing Home||Aging Waiver (Each spouse is allowed up to $1,063 / month) New Choices Waiver (Each spouse is allowed up to $2,349 / month)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||Aging Waiver ($1,063 / month for applicant) New Choices Waiver ($2,349 / month for applicant)||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$2,000||None||$1,437 / month||$3,000||None||$1,437 / month||$3,000||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.
When just one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, 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. However, this is not the case when one spouse of a married couple applies for regular Medicaid. In this situation, the income of both the applicant spouse and the non-applicant spouse is counted towards eligibility.
For married couples, with non-applicant spouses’ of institutional Medicaid applicants or HCBS Medicaid waiver applicants 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 do not become impoverished. Basically, if the non-applicant spouse, who is also called a community spouse or well spouse, has income under $2,155 / month, as of 7/1/20 (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 $2,155 / month). Based on one’s shelter and utility costs, an applicant spouse may be entitled to an even greater amount, up to $3,216 / month. (This figure will increase in January 2021.) To be clear, there is no spousal income allowance for non-applicant spouses of those applying for regular Medicaid. More on how Medicaid counts income.
*While there is no income limit for nursing home Medicaid, as indicated in the chart above, a beneficiary must pay nearly all of his or her monthly income to the nursing home. Medicaid-funded nursing home beneficiaries are entitled to only a personal needs allowance of approximately $45 / month, and if applicable, pay a monthly income allowance to a non-applicant spouse.
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 purposes, 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 lives in it or has “intent” to return to it, and his or her equity interest in it is not more than $595,000 (in 2020), is exempt. (The amount of the home’s value owned by the applicant is his or her equity interest in the home). The home is also exempt, regardless of any other circumstances, if the applicant is married and his or her spouse lives in it.
As of 2020, for married couples with just one spouse applying for Medicaid nursing home care or a HCBS waiver, the community spouse can retain half of the couples’ joint assets (up to a maximum of $128,640), as shown in the chart above. There is also a minimum standard, which is $25,728, and if a couple’s joint assets are equal to or less than this amount, the non-applicant spouse can retain 100% of it. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to ensure the non-applicant spouse has sufficient funds from which to live. There is no spousal resource allowance for non-applicant spouses of regular Medicaid applicants.
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 ones 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 his or her 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 eliminating 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.
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, 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.
How to Apply for Utah Medicaid
In order to apply for Medicaid in Utah, senior residents can do so online at myCase, download and submit a completed paper application (applications are found half way down the webpage), or apply in person at their local Department of Workforce Services (DWS) office. (To locate your local office, click here). 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.
Prior to submitting an application for Medicaid benefits in Utah, seniors need be certain that all eligibility requirements (as discussed above) for the program in 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. For additional information about applying for long-term care Medicaid, click here.