What is Utah's New Choices Waiver?
The New Choices Waiver (NCW) is a Utah Medicaid 1915(c) home and community-based services waiver for people who have been living long term in a nursing facility, assisted living facility, small health care (Type N) facility or another licensed medical facility, paying for supportive services so they can live in a home or community setting instead.
Utah operates nine Medicaid 1915(c) waivers, and New Choices is the one most Salt Lake families meet when assisted living is the goal. It is not an automatic Medicaid benefit: a person must meet its criteria and apply to the New Choices Waiver program office. Settings it allows include the person's own home, a friend's or relative's home, a certified independent living facility, a licensed assisted living facility, or a licensed community residential care facility.
Who qualifies for the New Choices Waiver in Utah?
An applicant must be at least 18, meet Utah Medicaid financial eligibility, need a nursing facility level of care, not have mental illness as the primary condition, not need an intensive skilled level of care, and not be eligible for an intermediate care facility for people with intellectual disabilities.
In addition, the person must be in one of these situations:
- Medicaid-paid nursing facility stay of 90 days or more
- Medicare-paid stay of at least 30 days in a licensed Utah medical institution, discharging to a Medicaid nursing facility for at least 60 days
- Already on another Utah HCBS waiver and in need of immediate or impending nursing facility care
- Living in a licensed assisted living facility or Type N small health care facility for 365 days or more
The 365-day path is the one that surprises families: a person who has privately paid for a year or more in a licensed Utah assisted living facility can apply from there, once their resources meet Medicaid limits.
Does the New Choices Waiver pay for assisted living rent?
No. New Choices is a medical program that pays for the services a participant is assessed to need; participants choose where to live as long as their needs can be met there and they can afford the room and board.
That split is the most important thing to understand before counting on the waiver. The resident's own income, usually Social Security and any pension, covers the room-and-board charge, and the waiver pays the facility for care services. Ask each facility whether it accepts New Choices residents, how many it takes, and what room-and-board rate it charges them. Services the waiver can cover include:
- Adult day care
- Adult residential services
- Attendant care
- Case management
- Chore and homemaker services
- Emergency response systems
- Home-delivered meals
- Medication assistance
- Non-medical transportation
- Respite care
- Specialized medical equipment
Is there a waiting list for the New Choices Waiver?
Utah DHHS says people living in nursing facilities, hospitals and other licensed medical institutions, and people already living in a licensed assisted living or Type N facility, may apply at any time during the year until the participant cap is met, and that it does not anticipate exceeding the cap.
The program still serves a limited number of people, and most of its slots are reserved for people living in nursing facilities, hospitals or other medical facilities. Someone living at home who has not used one of the facility paths generally does not qualify directly; for them, the Aging Waiver is the usual route, and it does have a waiting list.
How do I apply for the New Choices Waiver from Salt Lake City?
Contact the New Choices Waiver program office at 801-538-6155 (option 6) or 1-800-662-9651 (option 6), or newchoiceswaiver@utah.gov; applications are also available from Utah Medicaid's New Choices Waiver page.
Medicaid financial eligibility itself is decided by the Department of Workforce Services. Start both at once if a parent is in a Medicaid nursing facility stay or close to 365 days in assisted living. Once enrolled, a case management agency coordinates services; Salt Lake County Aging & Adult Services is among the agencies DHHS lists for New Choices case management.
At a glance
| The New Choices Waiver does | The New Choices Waiver does not | |
|---|---|---|
| Pay for | Assessed care services in a home or community setting | Room and board in assisted living |
| Serve | People leaving or long-term in facilities who need NF level of care | Anyone on Medicaid automatically |
| Enrollment | Accept facility-based applicants year-round until the cap | Guarantee a slot for people applying from home |
| Choice | Let participants choose where to live | Require a move into assisted living |
Sources include Utah Admin. Code R432-270, Utah DHHS and DLBC pages, Salt Lake County and DAAS pages, CareScout and VA rate tables as cited above; see our editorial standards.
