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. This page, however, is focused strictly on Medicaid eligibility for Utah elders, aged 65 and over. Specifically, long term care is covered. In addition to care services in nursing homes and assisted living facilities, UT Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Utah seniors may be eligible. These programs have varying financial and medical (functional) eligibility requirements, as well as 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; 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) – These are not entitlement programs; There are participant caps for enrollment and wait lists may exist. Intended to delay nursing home admissions, benefits are provided at home, adult day care, or in assisted living. More on Waivers.
3) Regular Medicaid / Aged, Blind or Disabled (ABD) – This is an entitlement program; 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.
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 the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Utah. More.
|2022 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 & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||Aging Waiver ($1,133 / month – eff. 3/1/22-2/28/23) New Choices Waiver ($2,523 / month – eff. 1/1/22- 12/31/22)†||$2,000||Nursing Home||Aging Waiver ($1,133 / month per spouse – eff. 3/1/22- 2/28/23) New Choices Waiver ($2,523 / month per spouse – eff. 1/1/22- 12/31/22)†||$4,000 ($2,000 per spouse)||Nursing Home||Aging Waiver ($1,133 / month per spouse – eff. 3/1/22- 2/28/23) New Choices Waiver ($2,523 / month per spouse – eff. 1/1/22- 12/31/22)†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged, Blind or Disabled||$1,133 / month (eff. 3/1/22-2/28/23)||$2,000||Help with ADLs||$1,526 / month (eff. 3/1/22-2/28/23)||$3,000||Help with ADLs||$1,526 / month (eff. 3/1/22-2/28/23)||$3,000||Help with ADLs|
†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This 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. Holocaust restitution payments and Covid-19 stimulus checks do not count as income, and therefore, do not impact Medicaid eligibility.
When just one spouse of a married couple applies for nursing home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means that regardless of the amount of monthly income a non-applicant spouse receives, it does not impact the income eligibility of the 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 income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA in UT is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income is under $2,288.75, income can be transferred 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 $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s income over $3,435 / month. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about 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. More on how Medicaid counts income.
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. There are also many assets that Medicaid does not count. 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, and in 2022, their home equity interest is not more than $636,000, is exempt. The amount of the home’s value owned by the applicant is their equity interest in the home. The home is also exempt, regardless of any other circumstances, if a non-applicant spouse lives in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. 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 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
Utah has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, 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.
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. Effective 3/1/22 – 2/28/23, the medically needy income limit in UT is $1,133 / month for a single applicant and $1,526 / 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 medically needy income limit. Persons can meet their “spend down” by paying a provider for medical services / goods. This may include 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 Medicaid 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” assets and become asset eligible. This can be done by spending excess assets on non-countable ones. 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 the look back rule was not violated.
3) 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 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
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 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
Senior residents can apply for Medicaid in Utah 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.