Medicaid for Nursing Homes in Utah: The 10A Rules
Updated September 15, 2026
Utah Medicaid pays for nursing home, or long-term, care once a person meets the state's "10A" criteria, a set of physical-need requirements that show they need 24-hour nursing care. Someone who doesn't meet 10A usually looks at the New Choices Waiver for assisted living instead.
What 10A checks
People in senior care call these rules "10A" for short, after the section of Utah's Medicaid rule, R414-502-3, that spells out who qualifies for nursing facility care. To approve someone, the state has to document at least two of these three things:
- Needs real physical help. Because of a diagnosed medical condition, the person needs significant hands-on assistance, not just reminders or someone setting things up, with at least 2 of the 6 core activities of daily living (ADLs), things like bathing, dressing, or transferring in and out of bed.
- Can't be safely reoriented. A physician has determined the person's confusion about where they are, what day it is, or who's around them is severe enough to require nursing facility care.
- Needs a more structured setting. The medical condition and the intensity of services required, things like IV antibiotics, a feeding tube, or daily wound care, mean the person's care can't be handled safely in a less structured setting, even with added home-based support.
The paperwork behind the decision
To confirm two of those factors are present, the state reviews a stack of clinical documentation:
- A current history and physical exam from a physician
- A full resident assessment completed and certified by a registered nurse
- A social services evaluation from a licensed social worker, or someone with a higher license
- A written care plan from a physician
- A physician's written certification that the person needs nursing facility placement
- Proof that less restrictive options were considered and ruled out first
Meeting the 10A medical criteria is a separate hurdle from financial eligibility. The same income and asset limits that apply to the New Choices Waiver apply here too, and clearing 10A doesn't skip that step.
Source: Utah Admin. Code R414-502-3, Nursing Facility Levels of Care (Utah Department of Health and Human Services).
Why the bar is high
Long-term care is expensive to provide: a doctor who visits on a regular schedule, nurses on staff 24 hours a day, and CNAs helping with daily care. Medicaid holds the line on 10A because it's paying for that entire level of staffing, not a lighter tier of help.
What happens if you don't meet 10A?
The usual next step is assisted living, covered in Utah through the New Choices Waiver. See how the New Choices Waiver works.
Where does the person's income go?
Once Medicaid is paying for long-term care, almost all of the person's monthly income, including Social Security and any pension, goes to the facility. They keep $45 a month for personal needs like haircuts, clothes, or snacks. A spouse who still lives at home is protected differently and can usually keep the house, a car, and part of the couple's savings; see how spousal protection works.
What are Utah's 10A rules for Medicaid nursing home coverage?
10A refers to Utah Medicaid rule R414-502-3. To qualify for nursing facility care, the state has to document at least two of three things: the person needs hands-on physical help with daily activities, is too disoriented to be safely reoriented, or needs a level of structure that can't be provided in a less restrictive setting.
Does meeting 10A automatically mean Medicaid will pay?
No. 10A is the medical criteria only. The person also has to meet Medicaid's separate income and asset limits, the same financial rules that apply to the New Choices Waiver.
Whether 10A applies or not, the next step is finding the right facility.
Find facilities that fit your loved one's care needs and budget.