Payment for Nursing Home Care, Utah Medicaid Program

The Utah Nursing Home Medicaid Program covers the cost of care in a long-term care facility, such as a nursing home, in addition to the ordinary medical services.

Income limit

The income limit is generally the amount the nursing home charges for a private-pay patient.   A client whose income is below the private-pay rate may be considered for Medicaid coverage of nursing home costs.   All of the client's income is considered in determining Medicaid eligibility, except for certain types of income excluded by federal law.  A person with income above the private pay rate may qualify if medical expenses exceed income.  If married, his or her spouse's income is not considered.

Deductions

Health insurance premiums and some medical bills paid for the person in a nursing home are allowable deductions.    Other deductions depend on whether the person is placed short-term for a stay of less than 6 months or long term.  A spouse at home is allowed to keep a portion of total income for living expenses.  There is both a minimum and a maximum amount of income the spouse in allowed to keep.  The minimum-maximum is adjusted annually.  The nursing home patient is allowed to keep only $45 for personal needs.  The remainder is paid to the State of Utah in exchange for Medicaid coverage.

Asset Limits (see definition of "assets")

Nursing home client - $2,000.00

For married persons with a spouse remaining in the home, assets are divided between husband and wife.  All assets are considered to be jointly owned even if only one member of the couple is shown as the owner. Special allowances for burial spaces and funeral plans.  The amount of the assets the spouse at home may keep is adjusted upwards each January.  As of January 2005, the spouse at home is allowed to keep at least $19,020 of the assets the couple owned when the client entered the nursing home, and no more than $95,100. Current limits can be found at the web site for the Centers for Medicare & Medicaid Services: http://cms.hhs.gov/medicaid/eligibility/      

Transfer of Assets

Sanctions apply if either (1) individual or spouse transfers assets within 36 months, or within 60 months if a trust, of application date for Medicaid, or (2) the individual transfers assets at any time after eligibility is determined. Nursing home costs are not paid during a sanction period.

Estate Recovery

The estate of a nursing home client age 55 and older may be subject to Estate Recovery. 

Retroactive Coverage

Medicaid covers nursing home charges only from the date the nursing home submits the Form 10 to the Department of Health.  (Form 10 is used to determine whether a client needs care in a nursing home.)   For all other medical services, considered ancillary charges,  the applicant may request coverage for medical services for up to three months prior to the month in which the the Medicaid application was filed.  A person who received medical, dental or mental health services and subsequently qualifies for Medicaid may return to each provider with a Medicaid Identification Card for the month in which service was provided. A provider who has already rendered services may subsequently choose to accept Medicaid as payment in full or refuse to seek Medicaid payment because the patient had not been determined eligible for Medicaid at the time of service.  If the provider accepts Medicaid, Medicaid may pay for the service.  If the provider refuses Medicaid, the patient is responsible for the charges.

How and Where to Apply for Medicaid

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