Utah Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Utah provides long-term care resources to seniors through the Department of Human Services, Division of Aging and Adult Services (DAAS). Information provided byDAASfor seniors includes help with finding insurance, information for meals and transportation services, the Utah Caregiver Support Program (UCSP) as well as home-and-community based services, such as the Medicaid waiver for seniors over 65 years of age. In 2016 over 1,900 Utah seniors received services in their homes, allowing them to live there instead of going into a skilled nursing facility. There are over 106 senior centers statewide and almost 20,000 Utah seniors eat at least one meal in their local senior citizen center. These services are provided locally through the 12 Area Agencies on Aging in Utah.

Medicaid Waiver Program for Assisted Living and In-Home Care

Waiver for Individuals Age 65 or Older, or “Aging Waiver”(HCBS Medicaid Waiver)

Thepurpose of the Aging Waiver to provide services statewide to help older adults remain in their homes or other community based settings. Individuals are able to live as independently as possible with supportive services provided through this waiver program. The waiver only serves a small population, limited to 600 in 2017. Further, waiver participants are only allowed services they are assessed as needing.

Services

Services include: Adult Companion Services; Adult Day Health Services; Case Management; Chore Services; Community Transition Services; Emergency Response Systems; Environmental Accessibility Adaptations; Fiscal Management Services; Home Delivered Supplemental Meals; Homemaker Services; Medication Reminder Systems; Non-medical Transportation; Personal Attendant Program Training; Personal Attendant Services; Personal Budget Assistance; Respite Care Services (May Be Provided in Long Term Care Settings); Specialized Medical Equipment; and Supportive Maintenance Home Health Aide.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: Utah does not have a special income limit, but usesSSI state criteria, so financial eligibility for Medicaid long-term care benefits is decided through either the traditional SSI-recipient standard, which limits an individual to an income of $735 or less to qualify. Additionally, Utah allows  SSI “medically-needy” category for its waiver program, also referred to as the “spenddown” program. To qualify for Medicaid, the person agrees to “spend down” his or her monthly income to the Medicaid income standard, which is 100% of the Federal Poverty Level or $1,005 in 2017. The asset limit for an individual applying for the waiver is $2,000. For the non-applicant spouse, they are allowed to keep $120,900 in assets and receive a monthly income of up to $3,022.50 without it affecting the eligibility determination.

Practical Considerations

As an SSI state, Utah has strict financial limits, but allows spenddown under the same rules as for Medicaid for nursing homes. The program is so small, at 600 enrollees, that it might not really be a viable option. The first step to determining whether the program is available is to contact the local Area Agency on Aging to see if there is space available.

Utah New Choices Medicaid Waiver (HCBS New Choices Waiver)

The New Choices Waiverprogram is designed to serve people who have been residing long term in a nursing facility, licensed assisted living facility, licensed small health care facility or other Utah licensed medical institution that is not an institution for mental disease. The program provides supportive services to enable individuals to live in their own homes or in other community-based settings. Individuals who are not actively residing in one of the above qualifying facility typesare not eligible to apply for the New Choices Waiver program.

Services

Services include: Adult Day Care; Adult Residential Services; Assistive Technology Devices; Attendant Care; Caregiver Training; Case Management; Chore Services; Consumer Preparation Services; Emergency Response Systems; Environmental Accessibility Adaptations; Financial Management Services; Habilitation Services; Home Delivered Meals; Homemaker Services; Community Transition Services; Medication Assistance Services; Non-medical Transportation; Personal Budget Assistance; Respite Care; Specialized Medical Equipment, Supportive Maintenance

Eligibility

  1. Health: Must require a Nursing Home Level of Care, not be eligible for an intermediate care facility due to an intellectual disability, and not have as their primary condition mental illness.
  2. Financial: The New Choices waiver has certain income and asset limits applicants must meet to qualify for Medicaid benefits for long term care. For 2017, the special income limit for an individual is $2,205 a month in income and a maximum amount of assets of $2,000. Under this waiver a Miller Trust, also known as a Qualified Income Trust is not permitted. However, the state offers an additional pathway to eligibility through the “medically-needy” category, which allows the applicant to spend down their income on medical needs to qualify for benefits.

Practical Considerations

The New Choices waiver program offers more available slots than the Aged & Disabled waiver, however, it is primarily reserved for seniors who are transitioning from a nursing home facility back to a community-based setting or their own home. The majority of available waiver slots will be reserved for long term residents of nursing facilities, hospitals and other Utah licensed medical institutions (excluding institutions for mental disease) and applicants who have lived in a qualifying facility type the longest will be given preference.

Conclusion

If you decide you want to use Medicaid benefits for long-term care in an assisted living facility or in home care, a Medicaid Planning specialist may help you by advising on how to best utilize the spenddown provision of the Aging Waiver so that you can maximize your benefit. Additionally, if you have been residing in a Nursing Home and receiving long-term care Medicaid benefits for longer than 90 days then the New Choices waiver could be an option. The eligibility criteria financially is a little more flexible than for the Aging & Disabled waiver but the health care criteria are very specific and a Medicaid Planning specialist would be able to assist you in making the right decision for your long-term care.