Medicaid for assisted living in Utah: the New Choices Waiver

Many families hear that “Medicaid pays for assisted living in Utah” and plan around it. The truth is narrower. Utah’s main path is a program called the New Choices Waiver, and its rules surprise people. Knowing them early can save a family from a painful mid-search reversal.

What the New Choices Waiver is

New Choices is a Utah Medicaid home and community-based services waiver. It gives people who would otherwise need a nursing home the option of living in a community setting instead, such as a licensed assisted living facility, their own home or a family member’s home, with Medicaid paying for the supportive services they are assessed to need. Those services include things like attendant care, medication assistance, respite and case management.

Medicaid assisted living requirements in Utah

Per the state’s fact sheets, an applicant must:

• Be at least 18 years old.
• Need a nursing facility level of care, but not an “intensive skilled” level.
• Meet Utah Medicaid financial eligibility rules.
• Have a primary condition that is not mental illness, and not be eligible for an intermediate care facility for people with intellectual disabilities.

And, the part most families do not expect, they must meet one of these living-situation requirements:

Utah Medicaid’s program page states it directly: people who are not living in one of these settings cannot apply. Someone living at home today, in other words, generally cannot go straight onto New Choices and into assisted living.

Waiting list and open enrollment realities

The fact sheets say New Choices “serves a limited number of individuals” and that most slots are reserved for people living in nursing facilities, hospitals or other medical facilities. Applications are taken any time during the year until the participant cap is reached. The state says it does not expect to exceed the cap, but that can change, and a person in assisted living competes for the smaller share of slots. Ask the program office about current availability when you call.

Two common paths Utah families take

• Private pay first. A resident pays privately in a licensed assisted living community for at least a year, spends down savings, and then applies, staying in a community that accepts New Choices.
• Nursing home to assisted living. A person on Medicaid in a nursing home for 90 days or more applies to move to an assisted living setting where their needs can be safely met.

How to apply

1. Apply to New Choices. The state says the fastest way is online through its PRISM application portal, linked from the New Choices page; first-time users create a UtahID account. Paper applications are available but slower.
2. Apply for Medicaid itself, if your loved one is not already enrolled, through the Department of Workforce Services at myCase, with the Medical Only Application and the Long Term Care Addendum.
3. Assessment and case management. A contracted case management agency assesses needs and writes a care plan. The state’s list includes agencies based in Ogden, Hooper and Davis County, among others, and participants can change agencies.

New Choices program office: 801-538-6155, option 6, or 1-800-662-9651, option 6 from outside the Salt Lake area. The state lists phone hours of 9 a.m. to noon on Monday, Wednesday, Thursday and Friday, with voicemails returned within a few business days. Medicaid eligibility questions go to DWS at 1-866-435-7414.

Finding assisted living in Utah that accepts Medicaid

A community must enroll with Utah Medicaid as a New Choices provider, and each level, such as Type I, Type II or secure memory care, is enrolled separately. So one building may accept New Choices in its Type II apartments but not its memory care unit. Ask each community:

• Are you an enrolled New Choices provider, and for which levels of care?
• How many residents on New Choices do you serve now, and do you cap it?
• What is your room-and-board charge for New Choices residents?
• If a private-pay resident converts to New Choices, can they keep their apartment?

That last question matters most if your loved one is starting out paying privately. Our assisted living overview and Utah assisted living cost guide can help you plan the private-pay stretch.

Common questions

Does Utah Medicaid pay for assisted living?

Through the New Choices Waiver it can pay for care services in a licensed assisted living facility, but not room and board, and only for people who meet the waiver’s level-of-care, financial and length-of-stay rules.

Can my mom go from home straight into assisted living on Medicaid?

Generally no. The program requires a qualifying stay in a nursing facility, hospital, assisted living or Type N facility, or enrollment in another Utah waiver with an immediate nursing-facility need.

Is there a waiting list for the New Choices Waiver?

The state describes enrollment as open year-round until a cap is reached, with most slots reserved for people in medical facilities. Call the program office for current availability.

Who decides if my loved one needs nursing facility level of care?

An assessment done as part of the application, using Utah’s level-of-care criteria. The person must keep meeting that level to stay on the waiver.