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This Utah Medicaid Home and Community Based Services (HCBS) waiver is designed to assist older individuals with elevated levels of care needs. It provides services that prolong independent living and prevent premature or unnecessary placement in nursing facilities. Compared to many state HCBS waivers, Utah's waiver offers a wide range of services beyond just personal care or companionship. For example, support is provided for medical equipment and any home modifications to increase independence. Support is offered for personal emergency response services, medication reminder systems, caregiver respite, and adult day care.
Unfortunately, support is not offered for consumer direction of services. Although Utah does have a waiver for the physically disabled that allows for self-direction or "self-determination", this waiver is not specifically intended for aging individuals.
Applicants must be:
Meeting Utah Medicaid standards is the most complicated component of determining eligibility. As of March 1, 2017, the countable income standard for a single applicant is $1,005 per month. Certain medical costs are deductible from one's countable income, for example, health insurance premiums and out-of-pocket expenses. The countable asset limit is $2,000. However, many resources are exempt, such as one's home—provided it is lived in by an owner or their spouse—and life insurance policies that don’t allow the option to cash them out.
For married couples with only one spouse applying for Medicaid there are additional rules and exemptions. The non-applicant spouse is referred to as the Community Spouse. They are permitted a higher level of income and assets to enable them to continue living independently. The Community Spouse may have up to half of the couple’s countable joint assets, up to $120,900.
Having too much income or assets does not prevent individuals from receiving Utah Medicaid, if they have extraordinarily high medical expenses. This group is referred to as Medically Needy recipients. If their monthly income, after their medical expenses have been deducted, is less than $500, they qualify for Medicaid and can access the waiver services.
Alternatively, Medicaid planners can guide families whose seniors are over the Medicaid income and asset limits. They do so by re-allocating funds in trusts, annuities, and other Medicaid exempt vehicles. Learn more about this option here.
In addition to the case management services provided to all waiver participants, the following benefits are available. All of which are chosen to increase the waiver recipient's ability to function independently of residential care in a nursing home.
This waiver is available statewide in Utah. However, like most HCBS waivers, there are a maximum number of slots available. Eligible individuals may find that they are placed on a waiting list. State officials delay starting benefits and services when the program is oversubscribed.
To get additional information, one can download a printable brochure about this program. To apply, one should contact their local Area Agency on Aging and start the process by requesting an assessment of the applicant.