FY 2016 Appropriation

Medicaid clients must meet nursing facility level of care as described in Administrative Rule R414.502 to receive this service. Clients must meet two of the following three conditions: (1) require substantial physical assistance for activities of daily living, (2) certain level of dysfunction in cognition, and (3) a less structured setting cannot provide the level of care needed. Additionally, clients must pass a low asset test to qualify for this service. Clients with primary residences that have more than $543,000 in equity are ineligible for nursing home services. The asset test includes a "look back period" of five years to examine asset transfers to determine if an inappropriate transfer of assets took place. Any findings of improper transfers delay Medicaid qualification. Once a client qualifies for nursing home care, there is no limit on the time they receive that care for as long as they continue to qualify. Additionally, federal law mandates that clients receiving this service must receive all benefits prescribed by their supervising physician. The Medicare program has a 100 day annual limit for nursing home services. Medicare clients who also qualify for Medicaid would have any nursing home service days above 100 paid for by Medicaid as long as the client continues to meet the nursing facility level of care requirements of R414.502.

Funding History
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $195,399,900 from all sources for Nursing Home. This is a 5.8 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $28,074,400 from the General/Education Funds, a reduction of 6.3 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Increase Nursing Home Medicaid Rates$12,542,100$0
OngoingOne-TimeFinancing Source
$8,819,600$0Federal Funds
$3,722,500$0GFR - Nursing Care Facilities Account
Increase Nursing Home Medicaid Rates - The Legislature provided $2 million one-time in FY 2015 to raise nursing home rates 3.6% in Medicaid. This funding would make that rate increase ongoing. In order to keep the cost neutral for the State $110,600 of the appropriation would be used for the increased cost to the State for hospice costs. The number of Medicaid clients in nursing homes has declined annually from a high of 3,130 in FY 2011 to 2,938 clients in FY 2014. This is a decline of 6.1% or 192 clients. How Measure Success? Report on rates implemented.
Use 3% Maximum from Nursing Restricted Account for Administration ($12,300) ($12,300)
OngoingOne-TimeFinancing Source
($12,300) ($12,300)GFR - Nursing Care Facilities Account
By statute 3% of the Nursing Care Facilities Account can be used for administration. The account was recently increased in FY 2014 and the administration is not currently at 3%. The reduction represents an exchange of these restricted account funds for General Fund and takes the State to using 3% on administration based on projected collections.

Medicaid nursing home clients may retain a fixed monthly amount for personal needs. For most individuals expected to stay longer than six months in long-term care the permitted allowance is $45 monthly. In most cases, the client's account balance cannot exceed $2,000 without risking a loss of Medicaid eligibility due to asset level requirements. Medicaid determines the amount of income the Medicaid client must pay to the facility in order to be eligible for Medicaid. This income is reduced from the Medicaid reimbursement paid to the facility.

The federal government's Centers for Medicare and Medicaid Services posts the results of nursing home inspections on their website. These surveys indicate the home's compliance with performance measure regulations.

The restrictions on building new nursing facilities is described in UCA 26-18-502 and UCA 26-18-503.

Any individual working in a nursing facility as a nurse aide for more than four months on a full-time basis must have successfully completed a nurse aide training and/or competency evaluation program approved by the State.

Reimbursement rates for nursing home services and calculation methodology are online at http://health.utah.gov/medicaid/stplan/longtermcare.htm. State law requires at a minimum that State-funded expenditures paid to nursing care facilities stay at June 2004 levels. There are quarterly adjustments to the rates paid to each nursing care facility based on the facility's average case mix (client severity). The Department of Health determines the nursing care rate based on three components:

  1. Fixed Rate - to pay for costs common to all facilities, such as food, laundry, and housekeeping.
  2. Property Rate - based on the fair rental value for Salt Lake City as well as property tax and insurance subject to a minimum and maximum reimbursement level.
  3. Case Mix Rate - distributes the remaining funds after the two rates above based on the level of clients' needs with a rural vs. urban adjustment.

Intent Language

HB0003: Item 81

Under Section 63J-1-603 of the Utah Code, the Legislature intends up to $3,500,000 provided for the Department of Health's Medicaid Management Information System Replacement in Item 72 of Chapter 282, Laws of Utah 2014 shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to the redesign and replacement of the Medicaid Management Information System.

SB0003: Item 121

The Legislature intends that the Medicaid Accountable Care Organizations receive a scheduled two percent increase effective January 1, 2016 consistent with the intent of S.B. 180, 2011 General Session.

SB0007S01: Item 5

The Legislature intends that the Department of Health report quarterly to the Office of the Legislative Fiscal Analyst on the status of replacing the Medicaid Management Information System replacement beginning September 30, 2015. The reports should include, where applicable, the responses to any requests for proposals. At least one report during FY 2016 should include the first estimate of net ongoing impacts to the State from the new system.

SB0007S01: Item 5

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Mandatory Services line item: (1) percent of adults age 45-64 with ambulatory or preventive care visits (Target = 88% or more), (2) percent of deliveries that had a post partum visit between 21 and 56 days after delivery (Target = 60% or more), and (3) percent of customers satisfied with their managed care plan (Target = 85% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 17

The Legislature intends that the Department of Health report quarterly to the Office of the Legislative Fiscal Analyst on the status of replacing the Medicaid Management Information System replacement beginning September 30, 2015. The reports should include, where applicable, the responses to any requests for proposals. At least one report during FY 2016 should include the first estimate of net ongoing impacts to the State from the new system.

SB0007S01: Item 17

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Mandatory Services line item: (1) percent of adults age 45-64 with ambulatory or preventive care visits (Target = 88% or more), (2) percent of deliveries that had a post partum visit between 21 and 56 days after delivery (Target = 60% or more), and (3) percent of customers satisfied with their managed care plan (Target = 85% or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

The monthly caseload is the number of Medicaid clients in nursing homes.

Display By:
Appropriation Type:
Appropriation History by
Show Table   |   Show Additional Information

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.