Utah’s New Choices Waiver is a Medicaid program intended to help elderly and disabled individuals who currently reside in a Medicaid-funded nursing home, assisted living community, or small health care facility. This 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. New Choices 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 allows for participant 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.
The New Choices Waiver is only for persons who are living in one of the settings mentioned above. 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: the Aging Waiver. The New Choices Waiver offers more liberal income requirements than does the Aging Waiver.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
To receive assistance under New Choices, individuals must meet several requirements:
- Resident of Utah
- At least 18 years of age and not suffering from a mental illness (for which there are other forms of assistance)
- If between 18 and 64 years old, must be disabled
- Requite a nursing home level of care
- Reside in a Medicaid-funded nursing home for at least 90 days, OR
- Reside in a Medicaid-funded assisted living facility for at least 365 days, OR
- Reside in a Medicaid-funded small health care facility for at least 365 days
For 2023, individual participants are limited to a gross monthly income of $2,742, which is equivalent to three times the current Federal Benefit Rate (FBR). For a couple with only one spouse applying, the income of the non-applicant spouse is not considered. In addition, the applicant spouse might be able to transfer part of his or her income to the non-applicant spouse. Currently, the maximum amount that can be transferred is $3,715.50.
The assets of an individual applicant are limited to $2,000. When the applicant is married and his or her spouse is not also applying for Medicaid, the non-applicant spouse is allowed up to keep up to $148,620 (in 2023) of the couple’s joint assets. This is in addition to the $2,000 in resources that the applicant spouse is permitted.
Over the Financial Limits?
Married individuals and persons with finances over these limits should consider finding Medicaid planning assistance. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their resources appropriately. Learn more.
A Word of Caution
It is vital that persons do not give away assets or sell them for less than fair market value within 60 months of one’s Medicaid application date. This is because doing so is a violation of the Medicaid look-back period and can result in Medicaid denial.
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
One can request application forms and instructions by calling the New Choices Waiver program office at 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.