Utah Aging Waiver: Medicaid-Funded Alternatives to Nursing Home Care

Last updated: May 31, 2024

 

Overview of the Utah Medicaid Aging Waiver

Utah’s Aging Waiver provides long-term home and community based services (HCBS) for elderly state residents. Intended for persons who require the level of care provided in a nursing home facility, supportive services are intended to prevent and delay unnecessary nursing home admissions. Availability of long-term services and supports vary based on the specific needs and circumstances of a program participant, but might include in-home personal care assistance, personal emergency response systems, home modifications for safety and accessibility, and respite care (in-home and out-of-home).

Persons can reside in their own personal home or the home of a loved one and receive benefits via the Aging Waiver. Program participants cannot reside in assisted living residences or adult foster care homes.

While the services offered under this program can be managed by an agency provider, participant-directed care is also an option for personal attendant services. This allows program participants to hire and manage the caregiver of their choosing, including friends and relatives, such as an adult child. In some cases, even a spouse may be hired. A Financial Management Services Agency handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments.

Utah’s Aging Waiver is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, there are a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.

Utah’s Aging Waiver is a statewide program and is formally called the Utah Waiver for Individuals Age 65 or Older or UT Waiver for Individuals Age 65 or Older. It is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of the Utah Medicaid Aging Waiver

In addition to case management, the following long-term home and community based services (HCBS) may be available. An individual care plan determines the exact benefits a program participant receives.

– Adult Companion Services – supervision, socialization, non-medical care assistance
– Assistive Technology
– Adult Day Health / Adult Day Care
– Chore Services – snow removal, lawn care, rodent / bug extermination
– Community Living Services – essential household items, moving expenses
– Enhanced State Plan Supportive Maintenance Home Health Aide Services
– Financial Management Services – for persons who are self-directing their care
– Home Delivered Supplemental Meals – for persons who are unable to prepare their own meals and have no one to do it for them
– Home Modifications (Environmental Accessibility Adaptations) – installation of wheelchair ramps, grab bars, modifying a bathroom to be wheelchair accessible, and widening of doorways for wheelchair access
– Homemaker Services – light housecleaning, laundry, preparing meals
– Medication Reminder Systems – medication dispenser device, phone calls, telecommunication devices
– Non-Medical Transportation
– Personal Attendant Services – assistance with daily living activities, such as bathing, dressing, eating, mobility, transitioning, preparing meals
– Personal Budget Assistance
– Personal Emergency Response Systems
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Specialized Medical Equipment
– Supportive Maintenance Home Health Aide Services

 

Eligibility Requirements for Utah Medicaid Aging Waiver

UT’s Aging Waiver is for elderly Utah residents aged 65 and older who also meet the criteria outlined below.

 The American Council on Aging now offers a quick and easy Utah Medicaid Eligibility Test for seniors. Start here.
Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 100% of the Federal Poverty Level (FPL), which increases annually in January. However, the Utah Aging Waiver income limits increase every March. Effective 3/1/24 – 2/28/25, a single applicant can have income up to $1,255 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $1,255 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,255 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance, from their applicant spouse. This rule is intended to ensure the non-applicant spouse does not become impoverished.

Utah has set a minimum Spousal Income Allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance, which in 2024, is $3,854 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs. A Spousal Income Allowance, however, can never push a non-applicant’s total monthly income over $3,854.

Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $2,000 per spouse. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.

In 2024, the CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Utah Medicaid has a Look-Back Rule and violating it results in a Penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Utah Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant’s spouse resides in the home.
– The applicant has a dependent relative living in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home here.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the UT Aging Waiver, the InterRAI MINIMUM DATA SET – HOME CARE (MDS-HC) tool is used by a registered nurse to make this determination. To meet a NFLOC, two of the following conditions must be met.

1) The individual has a diagnosed medical condition that results in the need for a significant amount of physical assistance with Activities of Daily Living (ADLs). This includes toileting, bathing, dressing, transferring, mobility, and eating.

2) The individual’s doctor has determined their orientation to time, place, and person is poor enough that nursing facility care is required or care equivalent to that through the services available through the Aging Waiver are required.

3) The individual’s medical condition and level of services required indicate their care need is such that without Aging Waiver services, their need cannot be safely met.

While it is common for persons with Alzheimer’s Disease or a related dementia to fulfill the Nursing Facility Level of Care need, a diagnosis of dementia in and of itself does not mean one will meet the level of care need.

 Utah seniors who currently reside in a Medicaid-funded nursing home, but wish to move back home or to another community based setting, such as an assisted living facility, should consider UT’s New Choices Waiver.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for UT Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

Utah has a Medically Needy Medicaid Program for Medicaid applicants who have high medical expenses relative to their income. Also called a spend-down program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit. The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, the Aging Waiver will pay for care services and supports.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid-Compliant Annuities, which turn countable assets into a stream of income, is another option. Yet another option, but one infrequently used these days and limited to married couples with a significant amount of assets, is a Medicaid Divorce. There are many other planning strategies available when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Utah to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.

 

How to Apply for the Utah Medicaid Aging Waiver

Before You Apply

Prior to applying for UT’s Aging Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

The Utah Aging Waiver is not an entitlement program; it is approved for a maximum of 550 beneficiaries per year. There is currently a waitlist called “The Applicant List”. Priority to a participant slot is established based on a Demographic Intake and Screening (DIS) Form. Persons who have a more immediate need for Waiver services, and a higher risk if Waiver services are not provided, are given higher priority. This means that in some cases, persons who submitted an application at a later date than other applicants are awarded a participant slot first because their risk is greater.

 

Application Process

To apply for the UT Waiver for Individuals Age 65 or Older, persons should contact their local Area Agency on Aging (AAA) office. As part of the application process, an Aging Waiver Demographic Intake and Risk Screening Form is completed to determine if minimum requirements are met and a Nursing Facility Level of Care need likely. These persons are then placed on the applicant list (waitlist) by priority level. Within 30 days of a participant slot becoming available, the MDS-HC is completed by a registered nurse to determine if the NFLOC is indeed met.

Learn more about the Aging Waiver here. Persons can also call the Division of Aging and Adult Services (DAAS) at 801-538-3910.

The Utah Aging Waiver is administered by the Utah Department of Health & Human Services’ Division of Medicaid and Health Financing. It is operated by the Division of Aging and Adult Services (DAAS). In turn, DAAS contracts with 11 Area Agencies on Aging (AAA) to provide assistance.

 

Approval Process & Timing

The Medicaid application process in Utah can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waitlist (The Applicant List) exists, approved applicants may spend many months, or longer, waiting to receive benefits.

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