Aging in Place in Your State: Utah

Photo by David Mark, Pixabay

This week, we take a look at home and vehicle modifications benefits for seniors in Evolve’s “home” state of Utah. Though we operate across the country, we are based in this unique western state, home of a half-dozen tribal homelands, world-class skiing, hiking, and bicycling; a vibrant and growing tech sector; and some of the nation’s most-visited national parks. 

The Beehive State was slower than some other states to adopt full Medicaid expansion, but as of 2020, the state offers an array of waiver benefits programs, including services to help people with autism, “medically fragile” children who depend on medical technologies, “medically complex” children, people with brain injuries, and people with physical and developmental disabilities. 

In addition, the state offers two waivers accessible to qualifying seniors: the New Choices waiver and the Aging waiver. Both of these waiver programs are funded and supervised by the Utah Department of Health’s Medicaid division, with the Aging waiver administered through the state’s 11 Area Agencies on Aging, who operate under a contract with the Utah Division of Aging and Adult Services. AAAs share information on waiver services with potential beneficiaries, help people find and enroll in the right waiver program, monitor expenditures people receive through waivers, review participants’ care plans, and help recruit providers for Medicaid-approved services.

New Choices Waiver

The New Choices program serves people who live in a nursing home, rehab, or other similar facility but who want to move into community-based living, and whose health and other needs will allow them to be served safely in a home-based setting. 

“New Choices Waiver offers an expanded package of supportive services that are intended to facilitate a participant's ability to reside in a home or community-based setting,” the state’s New Choices page reads. “Services are available based on the assessed need of the participant.” That means, of course, that approved recipients undergo a needs assessment to determine which waiver services they need.

Those services include a wide array of options, including adult day care and residential services, assistive technology and medical equipment, attendant care and medication assistance, chore/homemaker and habilitation services, personal budget and financial management help, meal delivery and transportation, and “environmental accessibility adaptions” to homes and vehicles.

To qualify, applicants must be at least 18 years old, meet Medicaid’s financial eligibility requirements and require a nursing-home level of care. In addition, they must NOT have a primary condition resulting from mental illness, must not require “intensive skilled” medical care, and must not be eligible to live in a care facility for people with intellectual disabilities.

There are also income and asset limits applicants must meet to receive benefits under the New Choices waiver. For a single person, the maximum allowable income is 100% of the Federal Poverty Level, currently $1,562 per month for a single person ($18,754 annually), or $2,105 for a couple ($25,267 annually). Applicants must have no more than $2,000 in countable assets, though there are many non-countable exceptions: a primary home with equity of no more than $595,000, household furnishings and other necessities, life insurance policies and funeral trusts, and a primary vehicle. Other assets valued at up to about $130,000 can be retained by a non-applicant spouse, and that same spouse can receive income of up to about $3,000 a month. People who exceed those income and asset limits, but who have significant ongoing medical expanses, may still be eligible for services if they qualify to be designated “medical needy.”

Qualified applicants can receive benefits for the installation of equipment or other home modifications “which are necessary to assure the health, welfare and safety of the individual or which enable the individual to function with greater independence in their home environment,” the state site reads. Recipients can also receive modifications to a primary vehicle that meet the same standard of necessity.

Note that the New Choices waiver is not an “entitlement” program, meaning that there are limits to the number of people served in any given year and at any specific time. This means there may be waiting lists to receive services, particularly as the program matures and more people apply. The same applies to the next waiver program, the Aging Waiver.

Aging Waiver

For seniors already living at home, and who want to remain there, Utah also offers a home- and community-based services Aging Waiver. Depending on the service, the Aging Waiver offers both consumer-directed and provider-based delivery. 

To qualify, applicants must be 65 years old or older, require a nursing facility level of care, and meet Medicaid’s financial eligibility requirements. They must also meet the same income and asset requirements as applicants for the New Choices waiver (see above).

Once approved, beneficiaries undergo an assessment to determine which services they need. These can include adult companions and personal attendants, case management and community living services, personal budget help and fiscal management, installation of emergency response systems and specialized medical equipment, home-delivered meals and homemaker services, respite care, chore and homemaker services, adult day health and home health aides, and “environmental accessibility adaptations,” or home modifications.

These home modifications should “assure the health, welfare and safety of the individual (and) enable the individual to function with greater independence,” according to the state Department of Health website. Purchase and installation of new resources is covered, as well as repair of existing resources if that is more cost-effective. Recipients work with their case manager to decide what adaptations they need; some of the most common the state mentions are installation of ramps and grab bars, widening of doorways and/or hallways, modifications of bathrooms and kitchens, modification of electrical and plumbing systems to accommodate medical equipment and care, and modifications to help control the temperature of a recipient’s living space.

Adaptations that add to a home’s total square footage are not eligible. Each adaptation that exceeds $2,000 in cost must receive prior approval from the Division of Aging and Adult Services, and the maximum allowable cost per adaptation is $5,000, though authorization for additional service beyond those limits may be authorized.

For more information on these and other waiver programs, visit Utah’s Medicaid page at https://medicaid.utah.gov/.