New Choices Waiver: Home Care and Support from Utah Medicaid

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through state-specific "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

Utah's New Choices Waiver (NCW) is a Medicaid program intended to help elderly and disabled individuals who currently reside in a Medicaid-funded, assisted living community, small health care facility, or nursing home. The program provides a variety of care services and supports to enable persons to move from their current community back into their homes or into the homes of family members and caregivers. The Waiver pays for supports, such as chore services, home access modifications, home delivered meals, non-medical transportation, and care services like adult day care and attendant care.

The New Choices Waiver is only for persons who are already receiving assistance from Medicaid for nursing home care. Utah offers a similar Medicaid waiver for those who require nursing home level care, but are not already receiving it and wish to remain living at home. This is called the "Elderly" or "Aging Waiver". The New Choices Waiver offers more liberal income requirements than does the Aging Waiver.

The New Choices Waiver allows for participant direction, often referred to as consumer direction or self-direction, of certain care services. For instance, friends and relatives can be hired to provide homemaker and attendant care services. However, spouses and legal guardians cannot be paid to provide care.

 

Eligibility Guidelines

To receive assistance under New Choices, individuals must be Utah residents who require a nursing home level of care, and eligible and receiving care services from Medicaid. As mentioned previously, applicants must be residing in Medicaid-funded nursing homes, assisted living facilities, or small health care facilities. In addition, persons must reside in those locations for a minimum period of time. For nursing home residents, they must live there for at least 90 days prior to their application for this waiver. For assisted living facilities and small health care facilities, applicants must have resided there for a minimum of one year.

In addition, applicants must be at least 18 years of age and not be suffering from a mental illness (for which there are other forms of assistance). Those between the ages of 18 and 64 must be disabled.

Utah Medicaid sets financial requirements for this waiver that differ from regular Medicaid admissions in the state. Individual participants are limited to no more than $2,000 in savings or other liquid assets and must have gross monthly income below $2,250. The asset and income limits are effective for 2018. This income limit is equivalent to three times the current Federal Benefit Rate.

Did You Know? The five cities in Utah with the highest percentage of residents 65 and older are Scofield, in Carbon County; Marysvale, in Piute County; Leeds, in Washington County; Antimony, in Garfield County; and Manila, in Duchesne County.

 

Benefits and Services

New Choices is intended to help persons who require nursing home level of care to return to their homes. As such, the following services and supports are available to help individuals directly and to help family members care for them.

  • Adult Day Care
  • Assistive Technology
  • Attendant Care
  • Caregiver Training
  • Case Management
  • Chore Services
  • Durable and Home Medical Equipment
  • Environmental Accessibility Adaptations (Home Modifications)
  • Financial Management Services
  • Habilitation Services
  • Home Delivered Meals
  • Homemaker Services
  • Medication Assistance Services
  • Personal Emergency Response Systems (PERS)
  • Personal Budget Assistance
  • Respite Care (In-home and Out-of-home)
  • Residential Care (Assisted Living / Memory Care)
  • Community Transition Services
  • Non-Medical Transportation

 

How to Apply / Learn More

State social workers prioritize individuals who currently reside in a state licensed nursing home or medical facility. For those who are interested in this program and do not currently live in a skilled nursing center, they must apply during three, 2-week, open enrollment periods starting on March 1, July 1, and November 1.

As this program is designed for persons already receiving Medicaid services and residing in nursing homes, interested parties should contact their nursing home or Medicaid administrators with questions regarding processes and availability. One can request application forms and instructions by dialing (800) 662-9651, and selecting number 6.

The New Choices Medicaid Waiver is operated by the Utah Division of Medicaid and Health Financing. For additional information about this program, click here.