Utah Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

Utah’s Medicaid expansion has one of the most unusual political histories of any state in the country.

Utah voters approved full ACA expansion to 138% FPL via a 2018 ballot initiative, with 53%+ support.

Then the state legislature passed a scaled-back version — capping coverage at 100% FPL through a Section 1115 waiver. Then the Biden administration withdrew the work requirement the state had attached. Then the full 138% FPL expansion took effect in January 2020.

And now, in 2026, Utah is pursuing a new work requirement waiver for expansion adults, with an effective date potentially as early as July 2026.

For current expansion enrollees and anyone applying for Utah Medicaid today: coverage is available up to 138% FPL with no work requirement currently in effect.

But that may change — and Utah’s expansion is more politically contingent than in most states.

Beyond expansion, Utah’s long-term care system centers on the New Choices Waiver (NCW) — an HCBS program with a distinctive focus on helping people transition out of nursing homes and assisted living facilities back into community living, with self-direction options and case management.

This guide covers every Utah Medicaid program, 2026 income limits, the New Choices Waiver, Utah’s multiple specialized waivers, the work requirement timeline, and how to apply through MyCase. For how Utah’s limits compare to other states, see Medicaid income limits across all 50 states.

A Brief History of Utah’s Expansion

Understanding Utah’s current Medicaid landscape requires a quick look at its unusual political path.

November 2018: Utah voters pass Proposition 3 — the Utah Medicaid Expansion Initiative — with 53%+ support. The measure calls for full ACA expansion to 138% FPL, funded by a state sales tax increase.

2019: The legislature passes SB 96, replacing the voter initiative with a narrower 100% FPL expansion through a Section 1115 waiver. The state sought to avoid the full cost of expansion.

April 2019: A partial expansion waiver takes effect — covering adults 0–100% FPL, not the 138% FPL voters approved.

January 2020: After legal and policy pressure, the full 138% FPL expansion takes effect, covering childless adults and parents up to 138% FPL. A Community Engagement (work) requirement also begins — and is suspended three months later due to COVID.

August 2021: The Biden administration withdraws federal approval for Utah’s work requirement, ending it entirely.

July 2025: Utah submits a new waiver amendment to CMS seeking work requirements for expansion adults with a target effective date of July 2026.

2026: Expansion coverage is available up to 138% FPL with no work requirement currently active. The July 2026 work requirement waiver is pending CMS review.

Utah Medicaid Programs

Medicaid Expansion Adults (19–64) covers adults earning up to 138% FPL ($1,799/month for a single person) with no asset test.

Depending on where you live in Utah, coverage is delivered differently:

• Urban counties (Salt Lake, Davis, Utah, Washington, Weber): Expansion adults enroll in a Utah Medicaid Integrated Care (UMIC) plan — a managed care model integrating physical and behavioral health through a single plan.
• Rural counties (Box Elder, Cache, Iron, Morgan, Rich, Summit, Tooele, Wasatch): Expansion adults enroll in an Accountable Care Organization (ACO) and a separate Prepaid Mental Health Plan (PMHP) for behavioral health and substance use services.

Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled Utahns who do not need nursing home care.

Income limit: $967/month (single). Asset limit: $2,000 (single).

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.

This is an entitlement — eligible applicants cannot be denied. Income limit: $2,901/month (single). Asset limit: $2,000 (single).

New Choices Waiver (NCW) is Utah’s primary HCBS program for seniors (65+) and adults with physical or other disabilities (18–64) who need nursing home-level care.

The NCW is distinctive in the series for its explicit nursing home transition focus — it’s specifically designed to help people who are already in a nursing home or assisted living facility move back to their home, a family member’s home, or another community-based setting. Transition services are a core part of the NCW benefit.

Beyond transition support, NCW covers: personal care assistance, adult day care, case management, respite, homemaker services, home modifications, assistive technology, personal emergency response systems, and home-delivered meals.

The NCW allows self-direction of care services — participants can manage their own care budget and hire personal caregivers, including certain family members.

Aging Waiver provides HCBS specifically for individuals aged 65 or older who need nursing home-level care, through adult day health, homemaker, personal attendant services, medication reminder systems, supplemental meals, and personal emergency response systems.

Acquired Brain Injury (ABI) Waiver serves adults 18+ with brain injury who meet nursing facility level of care.

Services include supported employment, community transition, environmental home and vehicle adaptations, residential habilitation, and behavior consultation.

Autism/IDD Waiver (Brain Injury/Autism/IDD Combined) serves individuals of any age with autism spectrum disorder, intellectual disabilities, or developmental disabilities who meet ICF/IID or nursing facility level of care.

Physical Disability Waiver serves adults 18–64 with physical disabilities.

Technology Dependent/Medically Fragile Children Waiver serves children 0–19 who are medically fragile and meet nursing facility level of care.

Services include personal attendant services, skilled nursing respite, and family support.

Children’s Medicaid / CHIP covers children up to age 19 with incomes up to 200% FPL. No asset test.

Pregnant Women covers pregnant women up to 200% FPL. Coverage extends 12 months postpartum. No asset test.

Targeted Adult Population — a specific Utah waiver subgroup covering adults 19–64 without dependents with incomes from 0–5% FPL who are chronically homeless or involved in the criminal justice system and in need of substance use or mental health treatment. This group is a unique Utah carve-out from the expansion population.

Income Limits — 2026

All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.

Key Notes on Utah’s Income Rules

Nursing Home / HCBS: Income above $2,901/month goes toward care costs after protecting a Personal Needs Allowance of $45/month and Medicare premiums.

At $45/month, Utah’s PNA matches Pennsylvania’s — lower than Texas ($75), South Carolina ($65), Rhode Island ($50), Tennessee ($50) and higher than South Dakota ($30).

If income exceeds $2,901, a Qualified Income Trust (QIT) redirects the excess to restore eligibility.

Community Spouse Allowance: The minimum MMMNA in Utah is $2,644/month (July 1, 2025 – June 30, 2026), with a maximum of $4,066.50/month if shelter and utility costs exceed the shelter standard.

Expansion work requirement status: No work requirement is currently in effect for expansion adults. Utah is pursuing a new CMS waiver with a potential July 2026 effective date. Monitor updates at medicaid.utah.gov for the current status.

Federal Poverty Level Reference — 2026

Use the federal poverty level calculator to find the exact threshold for your household size.

Asset Rules for Utah Medicaid

No asset test applies to expansion adults, children, or pregnant women. Asset limits apply to nursing home, HCBS Waivers, and ABD programs.

CSRA: The community spouse may keep up to 50% of the couple’s total countable assets, with a maximum of $162,660. If the non-applicant’s share falls below $32,532, they may keep up to 100% of assets up to that floor.

Home equity limit: $730,000. Primary home is exempt while the applicant or spouse resides there or intends to return.

Exempt (Non-Countable) Assets

• Primary home (within the $730,000 cap)
• One vehicle
• Household goods and personal effects
• Irrevocable Funeral Trusts (IFTs)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

Important note: Cryptocurrency and accessible retirement accounts (IRAs) are counted as countable assets in Utah for LTC programs. This differs from some states that exempt certain retirement accounts.

Utah’s 60-Month Look-Back Period

Utah enforces a 60-month (5-year) look-back for Nursing Home Medicaid and all HCBS Waivers.

When you apply, DHHS reviews all asset transfers within 5 years before your application date. Transfers below fair market value — including gifts — trigger a penalty period of ineligibility.

Important: Utah Medicaid checks transfers made by both spouses — not just the applicant. A non-applicant spouse who gave assets away within 5 years can still trigger a penalty.

Note that the federal annual gift tax exclusion ($19,000 per recipient in 2026) does not apply to Medicaid. Giving $19,000 to a family member within the look-back period can still generate a penalty period.

Exempt transfers:

• Transfers to a spouse
• Transfers to a blind or disabled child
• Home transfer to a caregiver child who lived there at least 2 years before institutionalization and whose care delayed nursing home placement
• Transfer to a sibling with an equity interest who lived in the home at least 1 year before institutionalization

No look-back applies to ABD Regular Medicaid, expansion adults, children, or pregnant women.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid or HCBS Waivers, applicants must demonstrate Nursing Facility Level of Care (NFLOC) through documented limitations in:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s, dementia, or other conditions — diagnosis alone does not guarantee NFLOC.

For ABD Regular Medicaid, proof of disability or blindness per SSA standards is required — NFLOC is not necessary.

Medicaid Estate Recovery

Utah’s Medicaid Estate Recovery Program may seek reimbursement for long-term care costs from a beneficiary’s estate after death.

Recovery most commonly targets the primary home. Exemptions apply for a surviving spouse, a child under 21, or a permanently blind or disabled child of any age living in the home.

Options If You Exceed the Limits

Qualified Income Trusts (QITs): If income exceeds $2,901/month, a QIT redirects excess into an irrevocable trust, restoring nursing home or waiver eligibility.

Utah Medicaid must be named as the trust beneficiary.

Irrevocable Funeral Trusts (IFTs): Pre-paid funeral costs in an irrevocable trust are exempt from asset limits.

Spend Down: Convert countable assets into exempt ones — home improvements, paying off debt, vehicle purchase, medically necessary equipment.

Medicaid Compliant Annuities: Convert excess assets into an income stream, reducing countable assets while directing income toward care.

How Utah’s Two-Agency System Works

Utah’s Medicaid administration involves two separate state agencies:

Utah Department of Health and Human Services (DHHS) administers the Medicaid program and sets policy.

Department of Workforce Services (DWS) determines eligibility for most Medicaid programs, including expansion adults and families — using the same MyCase portal also used for SNAP and unemployment insurance.

This split-agency structure means your Medicaid eligibility worker and your Medicaid benefits are managed by different agencies. Contact DWS at 1-866-435-7414 for eligibility questions and DHHS for program policy questions at 1-800-662-9651 for long-term care.

Federal Policy Changes Coming to Utah Medicaid

Work Requirements (potential July 2026 effective date): Utah submitted a new CMS waiver amendment in July 2025 seeking work requirements for expansion adults — with a target effective date of July 2026, ahead of the federal OBBBA January 2027 timeline.

No work requirement is currently active. If approved, exemptions are expected for pregnancy, disability, age 60+, caregivers of children under 6, and people unable to work due to medical conditions. Monitor medicaid.utah.gov for updates.

For context on how work requirements function across programs, see how SNAP work requirements apply — Medicaid work requirements follow similar logic. The full federal policy context: how the One Big Beautiful Bill affects Medicaid and SNAP.

Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application, down from 90 days. Apply promptly.

More Frequent Renewals (December 2026): Renewals shift to every 6 months for most enrollees. Use MyCase to renew online.

New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free. Seniors, children, pregnant women, and nursing facility residents are exempt.

Utah Medicaid and SNAP

Utah SNAP (the Utah Horizon Card program) is also administered through DWS — the same agency that determines Medicaid eligibility.

The MyCase portal at jobs.utah.gov/mycase handles both Medicaid and SNAP applications simultaneously.

Utah SNAP uses BBCE, removing the asset test for most households. Utah also recently enacted a soft drink purchase restriction for SNAP — Utah EBT cardholders cannot use SNAP benefits to purchase soft drinks at authorized retailers, making Utah one of the first states to restrict specific food categories under SNAP.

Useful links for Utah residents:

• Utah SNAP monthly benefits and eligibility
• How to apply for SNAP in Utah through the MyCase portal
• Utah WIC income guidelines
• Whether seniors on Social Security can also qualify for food stamps

How to Apply for Utah Medicaid

Online (Recommended): Apply through MyCase at jobs.utah.gov/mycase.

MyCase handles Medicaid, SNAP, and unemployment insurance through a single integrated portal — the same system used for workforce services. Create an account, complete the application, upload documents, and track your status.

By Phone: Call DWS at 1-866-435-7414 for Medicaid eligibility assistance.

For long-term care program questions (New Choices Waiver, Aging Waiver, nursing home): call DHHS at 1-800-662-9651.

By Mail: Download a paper application and mail to: Department of Workforce Services, P.O. Box 45200, Salt Lake City, UT 84145-0200.

In Person: Visit your nearest DWS office across Utah’s 29 counties. Utah’s rural areas — including the Uintah Basin, San Juan County, and the rural Southwest — may have limited office hours; MyCase online is often the best option for remote applicants.

For the complete step-by-step application guide: everything you need to know about applying for Medicaid in Utah.

Documents You’ll Need

• Utah residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC / ABD: bank statements, property records, 60 months of financial history; cryptocurrency holdings if applicable
• For disability: SSA disability documentation or physician letter
• For pregnancy: physician verification

Processing Times

• Standard applications: Up to 45 days
• Disability-based applications: Up to 90 days
• Pregnant women / urgent cases: Expedited processing available

Frequently Asked Questions

Did Utah voters approve Medicaid expansion?

Yes — Utah voters approved full ACA expansion to 138% FPL via the November 2018 ballot initiative with 53%+ support.

The state legislature then attempted to implement a narrower 100% FPL version through a waiver. After legal and political pressure, the full 138% FPL expansion took effect in January 2020. Utah was the sixth state to expand Medicaid through a voter ballot initiative.

Are there work requirements for Utah Medicaid expansion adults?

No work requirements are currently in effect.

Utah had a Community Engagement requirement that began January 2020, was suspended in April 2020 (COVID-19), and was formally withdrawn by CMS in August 2021. Utah submitted a new waiver amendment in July 2025 seeking work requirements with a target effective date of July 2026. That waiver is pending CMS review. Confirm current status at medicaid.utah.gov before applying.

What is the New Choices Waiver and what makes it unique?

The New Choices Waiver (NCW) is Utah’s primary HCBS program for seniors (65+) and disabled adults (18–64) who need nursing facility-level care.

What distinguishes NCW from most HCBS programs is its explicit focus on nursing home transitions — helping people who are currently in a nursing home or assisted living facility move back into community living. Transition services, case management, personal care assistance, home modifications, assistive technology, and respite care are all included. Participants can also self-direct their care services, choosing and managing their own caregivers.

What is UMIC and why does it matter for expansion adults?

Utah Medicaid Integrated Care (UMIC) plans are managed care organizations serving expansion adults in Utah’s five most populous counties (Salt Lake, Davis, Utah, Washington, Weber).

UMIC plans integrate physical and behavioral health coverage into a single managed care plan — similar to how Oregon uses CCOs. Rural expansion adults outside these counties instead use an ACO model with a separate Prepaid Mental Health Plan for behavioral health. Your county of residence determines which model you’re enrolled in.

Does the federal gift tax exclusion protect asset transfers from Medicaid look-back?

No — and this is a common misconception.

The IRS annual gift tax exclusion ($19,000 per recipient in 2026) only governs federal gift tax reporting. It has no effect on Medicaid’s 60-month look-back rule. Gifting $19,000 to a family member within 5 years of a Utah Medicaid LTC application can still trigger a penalty period of ineligibility.

Is cryptocurrency counted as an asset for Utah Medicaid?

Yes — Utah Medicaid counts accessible cryptocurrency holdings as countable assets for long-term care programs.

This means Bitcoin, Ethereum, and other digital assets must be disclosed and counted toward the $2,000 single asset limit for nursing home/waiver eligibility. Accessible IRAs may also be counted depending on how they’re structured. Consult a Certified Medicaid Planner to assess your full asset picture.

How do SNAP and Medicaid work together in Utah?

Both are administered through the Department of Workforce Services (DWS) and accessible through the MyCase portal at jobs.utah.gov/mycase.

A single application can establish eligibility for both simultaneously. Note that Utah has enacted a soft drink purchase restriction for SNAP — the Utah Horizon Card cannot be used to buy soft drinks at authorized SNAP retailers. See Utah SNAP eligibility and benefits for details.

What is the Targeted Adult population in Utah Medicaid?

The Targeted Adult Population is a Utah-specific waiver subgroup covering adults 19–64 without dependents with incomes from 0–5% FPL who are chronically homeless or involved in the criminal justice system and in need of substance use or mental health treatment.

This is distinct from the general expansion population and uses a separate funding structure. Contact DWS at 1-866-435-7414 for eligibility details.

Last updated: 2026 | Sources: Utah Department of Health and Human Services (DHHS), Utah Department of Workforce Services (DWS), medicaid.utah.gov, healthinsurance.org, KFF, USDA FPL guidelines, CMS.gov. Verify current work requirement status and income caps at medicaid.utah.gov or by calling DWS at 1-866-435-7414. This guide is for informational purposes only — eligibility is determined by DWS and Utah DHHS.