Medicaid Waivers and Benefits in Utah: New Choices Waiver in 2025

The New Choices Waiver is a Medicaid program in Utah that supports seniors and individuals with disabilities transitioning from institutional care settings, such as nursing homes, to more independent living arrangements. This program provides various services to help participants live safely and comfortably in their homes or other community-based environments. By addressing medical and non-medical needs, the New Choices Waiver enhances the quality of life while enabling individuals to maintain as much independence as possible.

Eligible Living Arrangements: The program allows participants to live in private homes, assisted living facilities, memory care units, or adult foster care settings. It also accommodates individuals moving from institutional care to a family member’s home or other suitable community-based housing. This flexibility helps ensure participants choose the environment best suited to their personal and medical needs.

Updated Financial Limits for 2025:

Income Limits: Applicants may have an income of up to $2,901 monthly to qualify for the New Choices Waiver. For couples, income is assessed individually, ensuring that one spouse’s eligibility does not impact the other.

Asset Limits: Single applicants must have countable assets under $2,000, while married couples applying together are limited to $3,000. The Community Spouse Resource Allowance (CSRA) permits non-applicant spouses to retain up to $157,920 in countable assets, protecting them from financial hardship.

Home Equity Limit: Applicants with home equity under $730,000 may still qualify if they or their spouse reside in the home or express intent to return. This limit ensures access to the program without forcing the sale of a primary residence.

Self-Directed Care Option: The New Choices Waiver provides self-directed care, allowing participants to hire and manage their caregivers. Caregivers may include family members or friends as long as they meet eligibility requirements. In some cases, even spouses can qualify to provide care. This option empowers participants to have greater control over their care and fosters a sense of autonomy. Financial Management Services agencies handle administrative responsibilities such as payroll, background checks, and tax reporting to simplify the process for participants.

Comprehensive Services Available: The program offers a wide range of services to meet the diverse needs of participants, ensuring they can safely remain in their chosen living arrangements. Examples of available services include:

Adult Day Care: Provides daytime supervision, social activities, and care in a structured group setting.
Home Modifications: Includes safety enhancements such as ramps, grab bars, and widened doorways to improve accessibility.
Transportation Services: Offers non-medical transportation for essential errands and appointments.
Assistive Technology: Provides devices such as safety alarms and amplified phones to support daily living.
Home-Delivered Meals: Delivers nutritious meals to individuals unable to prepare their own food.
Respite Care: Offers temporary care to relieve primary caregivers, either at home or in a facility.
Specialized Medical Equipment: Supplies necessary items to manage health conditions at home.
Financial Management Services: Assists participants with managing self-directed care.
Personal Emergency Response Systems (PERS): Provides devices that enable participants to call for help in emergencies.

These services address immediate and long-term needs, enabling participants to live more independently while receiving the required care and support.

Program Limitations: It is important to note that the New Choices Waiver is not an entitlement program. Enrollment slots are limited, and applicants who meet eligibility criteria may be placed on a waitlist when slots are full. Priority is often given to individuals who have spent longer periods in institutional care settings, reflecting the program’s goal of transitioning individuals to less restrictive environments.

Medical Eligibility Requirements: To qualify, applicants must demonstrate the need for a Nursing Facility Level of Care (NFLOC). This requirement ensures that the waiver is reserved for those who need significant medical or personal assistance. A comprehensive assessment evaluates the applicant’s functional and medical needs, determining their eligibility for the program.

Planning and Application Assistance: Preparing a complete application is critical to avoid delays or denials. Required documentation often includes proof of income, asset statements, and medical records. Missing or incomplete paperwork is one of the most common reasons for delayed approvals. Additionally, applicants must meet the financial and medical criteria at the time of application, as these requirements are strictly enforced. Professional assistance can significantly simplify the process and improve the chances of approval.

Contact Senior Planning for a free consultation to learn more about the New Choices Waiver in 2025. Our team specializes in Medicaid applications and can guide you through every step, from determining eligibility to submitting a complete and accurate application. With our support, you can navigate the complexities of Medicaid and focus on planning a secure and independent future.