Utah Medicaid Long Term Care Eligibility
Utah Long Term Care
1. Residency and Citizenship – the applicant must be a resident of Utah and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days. In Utah, individuals are entitled to Medicaid services under the plan during the 90 days predating the month of application if the person was, or would have been, eligible at that time.
3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 100% the Federal Poverty Guidelines ($980.83/month for 2015) to become eligible for Medicaid. If an applicant has excess monthly income they can spend down the excess, either paying it to the state or to the medical provider for medical bills. There is a $45/month personal needs allowance that is not figured into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Utah include:
i. $2,000 or less in cash/non-exempt assets if single.
ii. One home is exempt (equity limit $560,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Burial plans, not exceeding $1,500 in value.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. For a complete list of, very specific, excluded assets, click here and scroll down to “assets” in the menu on the left.
Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal a minimum of $23,844, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $1,967. The maximum amount of income that can be retained is $2,980.50 varying by case, depending on unique living expenses.
Utah programs and eligibility: https://medicaid.utah.gov/who-eligible
Long term care Ombudsman: http://daas.utah.gov/long-term-care-ombudsman/
Utah senior resources: http://ucare.dhs.utah.gov/help_for_seniors_resources.html
Utah Waiver Programs: http://health.utah.gov/ltc/AG/AGHome.htm
Utah state rules and codes regarding long term care: http://www.rules.utah.gov/publicat/code/r414/r414-01.htm#T6