Medicaid for Long-Term Care and Waiver Programs

Some people with special needs may qualify for Medicaid through waiver programs. In order for Medicaid to pay for long-term care, applicants must be financially and medically eligible. The individual may enter a medical facility such as a nursing home, or may be able to receive care in his or her own home under one of the home and community based waivers.

Space is limited in home and community based waivers and may not be available in all areas. Waivers allow Medicaid to pay for support and services that help people live safely in their own homes or the community. Each program has specific requirements and benefits.

For information about a waiver program, call the numbers below:

For information about how to apply for a waiver program provided by the Division of Services for People with Disabilities (DSPD), call (801) 538-4200.Programs offered through DSPD include:

Please visit the Medicaid Long-Term Care and Waiver Programs website for more detailed information about the programs.

Nursing Home

Nursing Home Medicaid will pay for nursing home and other medical costs. Some different income and asset rules apply for married couples. An individual must meet medical criteria for nursing home level of care to be eligible for Medicaid in a nursing facility.

Aging Home and Community Based Waiver

This waiver is a special program for members who would be medically appropriate for institutional care. These members are eligible for medical services that are not generally available to Medicaid recipients in community settings such as day treatment programs, lifeline, and in-home respite care. To be eligible for this program, members must be at least 65 years old. The referral process begins with the Area Agency on Aging (AAA). A case manager from AAA must complete an evaluation of the individual’s appropriateness for the waiver.

Utah Community Supports Waiver

This waiver is a special program that helps severely disabled people of any age remain in their homes rather than be institutionalized. Applications are taken through the Division of Services for People with Disabilities (DSPD). Parent's income and assets are not counted in determining a minor child's eligibility. Also, an intensive service plan is drawn up for the member. To be eligible for this program, members must have been disabled before age twenty-two.

Technology Dependent Children Waiver

A special program which helps medically fragile children remain in their home rather than be institutionalized. Children can qualify for this waiver through the month in which they turn 21. Members 21 and older who are admitted to the waiver prior to their 21st birthday may receive ongoing benefits. Applications are taken through the Division of Family Health Services. Parent's income or assets are not counted towards the child's eligibility. An intensive service plan is drawn up for the member and parents receive specialized training in how to provide some of the care the child needs. Families usually receive private-duty nursing services due to the complex medical condition of these children. To be eligible for this program, members must meet specific medical criteria.

Brain Injury Waiver

This waiver is a special program for members who have a brain injury and would be medically appropriate for institutional care. These members are eligible for medical services that are not generally available to Medicaid members in community settings such as supported employment, day treatment programs, behavioral training and in-home respite care. Policy follows the institutional policy except that the member is allowed higher income deductions. Applications are taken through the Division of Services for People with Disabilities (DSPD).

Physical Disabilities Waiver

Members who are eligible for this waiver would be medically appropriate for institutional care. Additional services the waiver may provide include: personal care assistance, consumer training and personal emergency response services. Policy follows the institutional policy except that the member is allowed higher income deductions. Applications are taken through the Division of Services for People with Disabilities (DSPD).

New Choices Waiver

The New Choices Waiver (NCW) provides home and community based services in community settings for eligible members who require the level of care provided in a nursing facility. The primary goal of the NCW is to move people out of institutional care to a less restrictive community care setting.  To be eligible for the NCW, an individual must be age 65 or older, or must be age 21 through 64 and meet SSA disability criteria.

Autism

Through a home and community based waiver proggram, Utah Medicaid currently offers autism spectrum disorder (ASD)-related services to a limited populations (children ages 2 through 6).  Under recent CMS guidance, Medicaid will provide ASD-related services to any eligible member under age 21 through the general Medicaid benefit.  

Medically Complex Children's Waiver

This program is intended to serve children with disabilities and complex medical conditions, providing them access to respite services, as well as traditional Medicaid services.  Unlike traditional Medicaid, only the child’s income and assets are considered when determining the child’s eligibility for this program; the parent’s income and assets are not considered.  Children can qualify for this waiver through the month in which they turn 19.  Applications are only accepted during open enrollment periods.