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 "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
This Utah Medicaid Waiver for Individuals Age 65 or Older, also known as a Medicaid Home and Community Based Services (HCBS) Waiver, or the Aging 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 also offered for personal emergency response services, medication reminder systems, caregiver respite, and adult day care.
The Aging Waiver program allows for consumer direction of personal care services. Via this service model, participants can hire friends and relatives, with the exception of spouses and legal guardians, to provide personal assistance. This includes assistance with daily living activities, such as bathing, dressing, preparing meals, and light housecleaning. While waiver participants can hire, train, and manage their care provider, the financial aspects of being an employer are handled by a Fiscal Management Agency through this waiver program.
The Aging Waiver is operated by the Division of Aging and Adult Services (DAAS) within the Utah Department of Human Services.
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Applicants must be:
Legal residents of the State of Utah
At least 65 years of age
Assessed and in need of nursing home level care
Financially eligible to receive Utah Medicaid
Meeting Utah Medicaid standards is the most complicated component of determining eligibility. As of February 24, 2019, the countable income standard for a single applicant is $1,041 per month. In other words, an individual cannot have income greater than this amount. (This amount equals 100% of the Federal Poverty Level, which changes on an annual basis).
The countable asset limit is $2,000. However, many resources are exempt, such as one's home, provided it is lived in by the applicant, the applicant intends to return to the home, or their spouse lives in it. In addition, the value of the home cannot be greater than $585,000. Other exemptions include life insurance policies, given the total face value is not greater than $1,500, irrevocable funeral trusts, one motor vehicle, and household furnishings.
For married couples with only one spouse applying for Medicaid there are additional rules and exemptions. Non-applicant spouses are referred to as Community Spouses. They are permitted a higher level of income and assets to enable them to continue living independently. Given the monthly income of the non-applicant spouse, an applicant spouse may supplement their non-applicant spouse’s monthly income in order to prevent them from becoming impoverished. As of 2019, this amount may be up to $3,160.50 / month. The Community Spouse may also have up to half of the couple’s countable joint assets, up to $126,420. This is called the Maximum Monthly Maintenance Needs Allowance (MMMNA).
Having too much income does not prevent individuals from receiving Utah Medicaid if they have extraordinarily high medical expenses. This group is referred to as Medically Needy recipients, and this program is often called a “Spend-Down” program. Certain medical costs may be deducted from one's countable income, allowing one to still be eligible for this waiver program. For example, health insurance premiums and out-of-pocket expenses may be deducted. If one’s monthly income, after their medical expenses have been deducted, is less than the monthly income limit, 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 to irrevocable funeral trusts, Medicaid compliant annuities, and other Medicaid exempt vehicles. Learn more about this option here.
Benefits and Services
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.
Adult Day Health Services - Social and care activities during daytime hours in a group environment
Chore Services - Light yard work and maintenance around one's home
Emergency Response Systems - electronic monitoring and call service for emergencies
Environmental Accessibility Adaptations - modifications to one's home or vehicle
Financial Management Services – support for consumer directed services
Home Delivered Meals - hot or prepared meals
Home Health Aide
Homemaker Services - laundry, housekeeping, cleaning etc.
Medication Reminder Systems
Personal Attendant Program Training
Personal Attendant Services
Personal Budget Assistance
Respite Care Services – to relieve the primary caregiver of their caregiving duties (in-home and out-of-home)
Specialized Medical Equipment - durable medical equipment for the home
Transition Services – back into the community
How to Apply / Learn More
Waiting lists for the Aging Waiver may exist. Contact your local Area Agency on Aging (AAA) for status. Find your local AAA.
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, click here. To apply, one should contact their local Area Agency on Aging and start the process by requesting an assessment of the applicant.