The Utah Medicaid New Choice Waiver program is a benefit that allows you to keep your income, and have Medicaid pay up to $2,200 per month towards the “supportive services” of your assisted living costs. For many, living in an assisted living facility is a much more desirable environment than living in a nursing home. Assisted living facilities provide a home-like environment with more privacy and control over your daily activities.
Its not my goal to explain all the details of the New Choice Waiver (“NCW”) program here, but I do want to point out some important aspects:
1. NCW is a “De-institutionalization” program.
The purpose of the New Choice Waiver Program (NCW) is to “De-institutionalize” existing nursing home residents by moving them from nursing homes to a home based or assisted living setting. Its cheaper for the State and people would rather live in an assisted living facility than a nursing home. Thus, when Utah set up its program, only current nursing home residents could apply. However, in 2013 that requirement changed, and Medicaid started to allow people who had lived in an assisted living facility for 180 days or longer, to directly apply for the NCW benefit without ever having lived in a nursing home.
2. The NCW program is an allocated program.
Each year, the legislature allocates the number of individuals that will be accepted into the program. In 2014 there were 1,800 “slots,” in 2015 there are 2,000. Their fiscal year runs from July to July.
3. The 2015 Changes.
When Utah amended its waiver program in 2014 to allow existing assisted living residents to directly apply for NCW after 180 days, the slots quickly filled up – in fact the state stopped taking applications on December 31. The program didn’t open again until July 1 of 2015 – and they made some changes. Here are the main ones:
♦ Of the 2,000 slots allocated for 2015, only 20% (400 are available to assisted living facility (“ALF”) direct application individuals.
♦ Application’s can only be filed during 3 Open Enrollment periods – March, July and November (approximately 1/3 of the allocated slots are used each period).
♦ Screening to receive a slot is based on the applicants length of residency in an ALF. The minimum length of stay has been expanded to 1 year (from 180 days). So essentially, once an individual meets the normal Medicaid qualifications, seniority determines if you get a slot.
4. NCW program for Nursing Home Residents.
Although the ALF direct application program has become more competitive and limited, the NCW program for existing nursing home residents is still a great benefit and can really provide a great solution for those elders who can function in an assisted living setting and have the right financial situation. Its available for the following:
- Those currently living in a Medicaid reimbursed nursing facility care on an extended stay basis of 90 days or more; or
- Those who are Receiving Medicare reimbursed care in a licensed Utah medical institution (that is not an Institution for Mental Disease), on an extended stay of at least 30 days, and will discharge to a Medicaid certified nursing facility for an extended stay of at least 60 days; or
- Those Receiving Medicaid reimbursed services through another of Utah’s 1915(c) waivers and have been identified as in need of immediate or impending nursing facility care; and
Applying for the New Choice Waiver program still requires that the applicant first qualify for Medicaid. So, when applying you actually must file two separate applications. One for the New Choice Waiver program and one for the regular Medicaid program. Its a bit of a circular problem. If you don’t qualify for regular Medicaid, you don’t qualify for the New Choice waiver program. If you qualify for regular Medicaid, that doesn’t mean you also qualify for the NCW program. They actually look at the NCW application first, and if you qualify, then they consider your long term care Medicaid application. That means, even if NCW says you qualify for their program, if you don’t meet the LTC Medicaid requirements, you won’t get either benefit. Bottom line – it all boils down to whether you meet the financial tests of regular long term care Medicaid. So, that’s where we start. And that means we need to use all of the strategies I use to help people arrange their assets to save resources and meet the eligibility requirements.
This just gives you an overview – and the exact details of your unique situation will dictate how we should proceed. However, what I want you to take away from this is – the NCW program is a great program and really can be the perfect solution for your loved one. Living in an assisted living facility is a much better than living in a nursing home for those that can live with less hands on nursing home care, but still meet the level of care required to qualify for Medicaid.