Medicaid for Assisted Living: Utah's New Choices Waiver

In Utah, Medicaid can pay part of the monthly cost of assisted living through a program called the New Choices Waiver. To qualify, income and assets have to fall under state limits, and families get into the program either by paying privately for a year or by spending 90 days in a skilled nursing facility first.

Having Medicaid is not the same as having the waiver

This is the single most common misunderstanding, and it costs families weeks. Utah Medicaid and the New Choices Waiver are not one thing. You can be on Medicaid and still not have the waiver — it is a separate application, with its own eligibility, and a community that bills the waiver cannot bill it for you until you have it.

If someone tells you a community "takes Medicaid", ask the more specific question: do they take the New Choices Waiver, and is the person on it yet?

Medicare is a third thing again, and it pays for none of this. Medicare does not pay for you to live at home, and it will not pay your cost of living in assisted living or a nursing home either.

Who qualifies?

Qualifying for Medicaid comes down to two numbers falling under state limits: income, the money that comes in monthly from Social Security or a pension, and assets, the things a person owns that are worth money, like a savings account.

Over the limit? Spending down

Families over the asset limit can do a "spend down," spending money until they fall under it. The rules about how you're allowed to spend matter more than most people expect, so get advice before you start, not after.

The 5-year look-back

When you apply, Medicaid checks the past 5 years for money or property that was given away, or sold for less than it was worth: a house transferred to adult kids, a large cash gift to a family member. Find something like that, and Medicaid can delay when coverage starts. Talk to an elder law attorney before giving away or spending anything, not after the fact.

Protecting the spouse who stays home

Moving one spouse into care doesn't mean the other loses everything. Medicaid has rules that let the at-home spouse keep the house, a car, part of the couple's savings, and in some cases part of the income. Exactly what applies depends on the situation, so ask a caseworker or elder law attorney directly.

Two ways into the New Choices Waiver

1. Pay for assisted living privately for one year. If a spend-down is coming anyway, this is usually the simpler route.
2. Spend 90 days in a skilled nursing facility, a center with nurses and therapists on staff. During those 90 days, the family has to show the person doesn't need that level of care and would do well in assisted living. The 90 days can be a short-term rehab stay or time as a long-term care resident.

Two things to check before you move in

Some assisted living facilities don't accept the New Choices Waiver at all. Paying for a full year at a facility, only to learn later that it won't take the waiver, can mean a second move for your loved one, which is hard on seniors. Ask this before signing anything: "Do you accept the New Choices Waiver?"

The waiver also tends to cover part of the bill, not all of it. For example:

These numbers are an example only. What the waiver pays can vary.

What if assisted living isn't enough care?

Medicaid covers nursing home care differently, through Utah's 10A level-of-care rules. See how 10A works.