Utah Medicaid Documentation Requirements: What DWS Needs

The Paper Trail That Determines Eligibility

A Utah Medicaid long-term care application is fundamentally a documentation exercise. DWS caseworkers don't make judgment calls about whether your parent deserves help — they check whether the submitted evidence satisfies specific eligibility requirements. Missing a single document category can stall the application for weeks or trigger a denial.

Here's the complete inventory of what DWS needs.

The Application Forms

Form 61MED (Medical Only Application): The standard paper application for all Utah medical assistance programs. This covers demographic information, household composition, and basic financial declarations.

Long-Term Care Addendum (Form 61LTC): A required supplemental form that captures details specific to institutional and waiver services — current living arrangement, care facility information, and additional financial disclosures.

Form 114AR (Authorization to Disclose Medical Eligibility Information): If an adult child or other representative is acting on the applicant's behalf, include this authorization so DWS can communicate with them about the case.

Submit the signed application package online via myCase (jobs.utah.gov/mycase) or by fax to the centralized DWS imaging line at 1-877-313-4717.

60 Months of Financial Records

DWS requires five full years of financial documentation to evaluate the lookback period. For every account the applicant (and their spouse) has held during the past 60 months, you'll need monthly or quarterly statements from all checking accounts, savings accounts, CDs, and money market accounts, brokerage and investment account statements, IRA and 401(k) statements (Utah counts both spouses' retirement accounts as countable resources), life insurance policy statements showing the face value and cash surrender value, and any records of closed accounts — including final statements and confirmation of where the remaining balance went.

Gaps in the record are red flags. If your parent closed an account three years ago and can't produce the final statement, DWS will ask where the money went. If you can't answer, the missing funds may be treated as an uncompensated transfer, triggering a penalty period.

Banks typically keep digital statements for 7 years, but you may need to request older records in writing. Start this process early — some institutions charge fees for archived statements and take 2 to 4 weeks to produce them.

Property and Real Estate Records

If your parent owns real property — even just their primary home — DWS needs documentation of current assessed value or recent appraisal, mortgage statements (if any balance remains), property tax assessments, and the deed showing current ownership. In 2026, the primary home is exempt from the asset calculation up to $752,000 in equity, but DWS still needs to verify the equity falls within that limit.

If any property was transferred during the lookback period — including adding a child's name to the deed — you'll need records of the transfer, what was paid, and whether fair market value was received.

Income Verification

Monthly income documentation for both spouses: Social Security award letters (SSA-1099), pension statements, annuity contracts, rental income records, and any other recurring income. DWS uses gross monthly income — before taxes, Medicare premiums, or any other deductions.

Clinical Documentation: Form 927

Separate from the financial application, the clinical track requires Form 927 (Waiver Referral / Level of Care Form), completed by a licensed healthcare professional who has evaluated the applicant. This form establishes that the applicant meets the Nursing Facility Level of Care standard and sets the clinical start date for eligibility.

Form 927 is valid for only 60 days. Coordinate closely between the clinical assessment timeline and your financial document collection so neither expires while you're waiting on the other.

For applicants in a nursing facility, the facility's clinical team handles Form 927. For home-based applications (Aging Waiver), contact the regional Area Agency on Aging or the Medicaid OLTSS office to request the assessment.

Common Mistakes That Delay Applications

The most frequent documentation failures: missing months in the bank statement sequence (DWS notices every gap), failing to include the spouse's financial records (Utah counts both spouses' assets), not providing documentation for closed accounts, submitting unsigned forms, and waiting to start the clinical assessment until the financial package is complete (run both tracks simultaneously).

Our Utah Medicaid Long-Term Care & Asset Protection Guide includes a document collection tracker organized by category and timeline — so you can systematically gather everything DWS requires without discovering gaps after you've already submitted.

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