Low Income Seniors at Risk

Another Assisted living community in Utah closed its doors last week, forcing dozens of vulnerable low income seniors on the New Choices Waiver (NCW) to relocate, with another major provider in Utah just announcing its end with Medicaid contracts this year, this poses a serious issue. This is part of a growing crisis with Utah losing hundreds of New Choices Waiver beds in the last few years. The core issue is simple; more and more assisted living communities can no longer afford to take NCW clients.

What is The New Choices Waiver?

NCW is the Utah Medicaid Waiver program specifically created to-and does-save the state money by helping seniors move from high-cost nursing homes to lower-cost assisted living settings with supported services. It is a smart model; cost-effective, person-centered, and supportive of aging in place with more and better options for seniors. But the program hasn’t kept up with economic realities. Today, the NCW reimburses assisted living communities just $79/day or $2,370 per month. (Memory care is $90/day) Residents in those communities typically contribute an additional $500–$1,000 as their “share of cost” from their limited social security income bringing the total revenue to around $2,870–$3,370 per NCW client. That might have worked 10 years ago; but nowadays it puts communities at a loss.

What does Assisted living generally cost?

The average cost of assisted living in Utah is now over $5,000 per month. That’s not price gouging that is reflecting real costs: housing, staffing, food, utilities, personal care, and compliance. With communities operating on thin margins, especially in rural areas, taking NCW clients means operating at a loss. As expenses rise and buildings age, many are making difficult choices to either close entirely or convert to more profitable uses like inpatient treatment centers, halfway houses or even just sitting empty. This leaves the remaining NCW-participating communities overwhelmed and under-resourced. As staffing shortages and burnout increase, the quality of care inevitably declines. And when those facilities finally close, the displaced residents have few, if any, options left. In many cases, they end up in skilled nursing facilities, the very outcome the NCW was designed to avoid, at two times the cost to the Medicaid system.

So what is the solution?

The solution is clear: Utah Legislature must increase the New Choices Waiver reimbursement rate for assisted living providers. Without a significant increase, the system will continue to unravel, and the cost to taxpayers will balloon as more seniors are forced into institutionalized nursing home care. The NCW remains a smart and fiscally responsible program, but only if we invest in it to meet today’s economic demands.

The Utah Assisted Living Association is asking for an increase to $120/day in the 2026 LEG session. If the UTLEG does this, they just might save the program. If not, we will spend more medicaid resources to move these seniors back to a skilled nursing facilities.

Here is the video of testimony to the Social Services Subcommittee from a few years ago. We predicted this exact issue would arise.

What can you do?

The Utah Legislature controls the purse strings for Medicaid spending. Specifically, the Social Services Appropriations Subcommittee. This the committee that will make recommendations to the Medicaid funding for the New Choices Waiver.

If any of these state senators or representatives are your state elected leaders, you need to contact them and tell them about this issue. You can look up who your state reps are here. Even if they are not your state reps, you should still email them your concerns. But your should specifically reach out to your reps, even if they are not on the committee. (yes, you can email them this post)

Committee Members: