Overview of Utah’s Medicaid State Plan Personal Care Services
Utah’s Medicaid State Plan Personal Care Services is for individuals with chronic conditions, including those associated with the natural process of aging, and persons with disabilities. Intended to prevent and delay unnecessary nursing home admissions, in-home personal care assistance is provided to assist persons in living independently. This includes assistance with Activities of Daily Living (ADLs), such as bathing, dressing, mobility, eating, and toiletry. Persons may also receive medication reminders and transportation for essential shopping, such as buying groceries.
Persons can reside in their own personal home or the home of a loved one and receive personal care services. Program participants can also reside in assisted living residences or adult foster care homes.
Many long-term care Medicaid programs offer a participant-directed option, allowing program participants to choose, hire, and manage their own caregiver. Unfortunately, this is not an option for UT Medicaid State Plan Personal Care Services. Instead, services are provided through an agency provider.
UT’s Personal Care Services is an entitlement; meeting eligibility requirements equates to immediate receipt of program benefits. In other words, there is never a waitlist to receive services.
Utah’s Medicaid State Plan Personal Care Services is part of Utah’s Regular State Plan Medicaid program.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of the State Plan Personal Care Services
A personal care plan determines the exact personal care services and the hours of assistance (up to 60 / month) that a program participant can receive. Personal care services may include assistance with the following.
– Ambulation – i.e., assistance with moving about, including assistance with walkers, canes, and wheelchairs
– Bathing & Personal Hygiene
– Basic Foot Care – i.e., filing and trimming nails
– Eating
– Household Tasks (that are essential to health and safety) – i.e., moving furniture to allow one to more easily move about the home
– Meals – i.e., planning, preparing, and clean-up of meals
– Medication Reminders & Supervision
– Tooth / Denture Care
– Toiletry – i.e., getting to and from the toilet, using it, and cleaning oneself
– Transportation – i.e., for essential shopping and doctor appointments
Eligibility Requirements for Utah’s State Plan Personal Care Services
UT’s Personal Care Services are available to state residents of all ages who meet the eligibility criteria. The following criteria is relevant for persons who are aged 65 and over.
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, for Utah’s Medicaid State Plan Personal Care Services, the income limits increase in March. Effective 3/1/24 – 2/28/25, a single applicant can have income up to $1,255 / month. When an applicant is married, regardless of whether or not their spouse is also an applicant, there is a couple’s income limit of $1,703 / month.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with one or both spouses as applicants, the asset limit is $3,000.
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.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is not relevant for Utah Medicaid State Plan Personal Care Services.
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.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant to have a Nursing Facility Level of Care (NFLOC) need, this is not true for Utah’s Medicaid State Plan Personal Care Services. Instead, to be eligible, one cannot be bedbound (unable to leave their bed) and they must require assistance with a minimum of 2 of the following:
– Remembering to take their medication(s)
– Toiletry – i.e., toilet or bedpan
– Bathing / Showering
– Skin Care
– Moving About (including with the use of canes, walkers, and wheelchairs)
– Personal Grooming (i.e., dressing, shaving, and hair care)
– Meals (i.e., planning, preparing, and cleaning up)
Personal care services must also be deemed necessary by a physician.
While it is common for persons with Alzheimer’s Disease or a related dementia to fulfill the level of care need, a diagnosis of dementia in and of itself does not mean one will automatically meet the functional need.
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, Medicaid will pay for care services and supports.
When persons have assets over the limits, they can “spend down” excess assets. This includes making safety and accessibility home modifications, home repair projects, and buying home furnishings. Persons can also purchase Irrevocable Funeral Trusts (IFTs). IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. 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. Furthermore, while it is thought that Medicaid’s 60-month Look-Back Rule does not apply to Utah’s Medicaid State Plan Personal Care Services, some persons will go on to require more extensive care, such as home and community based services via a Medicaid Waiver or Nursing Home Medicaid. For these programs, the Look Back Rule is relevant, and violating it results in a Penalty Period of Medicaid ineligibility. While there are many Medicaid planning strategies, they should only be implemented with careful planning well in advance of the need for long-term care. 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 Utah’s State Plan Personal Care Services
Before You Apply
Prior to applying for UT’s Medicaid State Plan Personal Care Services, 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, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
Persons must be enrolled in Utah Medicaid in order to receive UT Medicaid State Plan Personal Care Services. Persons can apply for Medicaid online at myCase, by calling the Department of Workforce Services (DWS) at 866-435-7414, in person at one’s local DWS office, or by completing a paper application and mailing it to the address indicated on the application.
Persons enrolled in Utah Medicaid should contact their local DWS office to initiate the process of receiving personal care services. This will include a personal care assessment completed by a licensed registered nurse.
Although not intended for a consumer audience, one can learn more about Utah’s Medicaid State Plan Personal Care Services in the Utah Medicaid Provider Manual.
Utah’s Medicaid State Plan Personal Care Services is administered by the Utah Department of Health, Division of Medicaid and Health Financing. Eligibility is determined by the Department of Workforce Services.
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.