Utah Medicaid Waivers & Home and Community Based Programs Overview
- Waiver Policy Analyst
- Feb 4
- 2 min read
Utah, known as The Beehive State, has a well-structured Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.
Administered by the Utah Department of Health and Human Services (DHHS), Division of Integrated Healthcare (DIH), and the Division of Services for People with Disabilities (DSPD), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional care.
Key waiver programs include the Aged and Disabled (AD) Waiver, which provides personal care, respite, and home modifications for seniors and adults with physical disabilities, and the Community Supports Waiver, which offers residential, employment, and behavioral health support for individuals with intellectual and developmental disabilities (IDD).
Other significant programs include the Acquired Brain Injury (ABI) Waiver, the Medically Complex Children’s Waiver (MCCW), and the New Choices Waiver (NCW), which assists individuals transitioning from institutional settings to home and community-based care. Utah also offers Self-Administered Services (SAS), allowing waiver participants to manage their own care and select their caregivers.
Regulatory oversight in Utah is managed through DHHS, DIH, and DSPD, with additional provider licensing and compliance enforcement handled by the Office of Licensing and the Bureau of Health Facility Licensing, Certification, and Resident Assessment.
The state operates under both fee-for-service and managed care models, with HCBS services integrated through Utah Medicaid’s Accountable Care Organizations (ACOs) to enhance service coordination and cost-effectiveness. Utah has also implemented Electronic Visit Verification (EVV) for personal care services, ensuring compliance and service integrity. Providers must navigate Medicaid enrollment, prior authorization requirements, and strict quality assurance measures to participate successfully in the state’s HCBS programs.
With a strong emphasis on community integration, self-direction, and person-centered planning, Utah’s Medicaid waiver system ensures that individuals receive high-quality, sustainable long-term care while maintaining independence, dignity, and inclusion in their local communities.
Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.
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