Utah Medicare to Medicaid Transition: What Happens After 100 Days

The 100-Day Cliff

Medicare covers skilled nursing facility care after a qualifying 3-day hospital stay — but only for a limited window. The first 20 days are paid in full. Days 21 through 100 require a daily copayment of $217 in 2026. After day 100, Medicare coverage ends entirely. The 100-day period is a maximum, not a guarantee; coverage can end earlier if Medicare's coverage requirements are no longer met.

When the Medicare coverage runs out, families face the full private-pay rate — averaging around $7,600 per month for a semi-private room in Utah. That's the moment most families realize they need to apply for Medicaid long-term care, and the clock is already ticking.

Start the Medicaid Application Before Medicare Ends

The single most important piece of timing advice: don't wait until Medicare coverage actually stops. DWS takes up to 45 days (sometimes 90 if a disability determination is needed) to process a long-term care Medicaid application. If you submit on the day Medicare runs out, you're looking at one to three months of private-pay bills while DWS reviews your case.

Instead, begin assembling your application during the Medicare-covered rehabilitation period. The nursing facility social worker should initiate a clinical level-of-care assessment (Form 927) while the patient is still receiving Medicare coverage. This dual-track approach means the clinical piece is already done by the time the financial application moves through DWS.

Retroactive Coverage Can Save Thousands

Utah Medicaid can cover qualifying care costs for up to three months prior to the application date, as long as the applicant met all eligibility requirements during those months. This means if your parent became financially and clinically eligible in February but you didn't submit the application until May, Medicaid can retroactively pay for February, March, and April.

This retroactive window exists specifically for situations like the Medicare-to-Medicaid transition, where families often don't realize they need to apply until costs are already piling up. But it only works if the applicant already met the applicable asset limit during those prior months. If you were still spending down assets during the retroactive period, those months may not qualify.

The Income Transition

On Medicare, your parent's income wasn't a factor in coverage. Under Medicaid, income matters — but unlike many states, Utah doesn't impose a hard income cap that disqualifies high-income applicants. If your parent's gross monthly income exceeds the Special Income Group limit of $2,982, Utah uses its Medically Needy spend-down pathway rather than requiring a Miller Trust (which Utah doesn't recognize).

The spend-down means your parent pays their excess monthly income toward their care costs, keeping only the $45 personal needs allowance. The practical effect: most of their Social Security, pension, and other income goes directly to the nursing facility each month, and Medicaid covers the remainder of the bill.

Coordinating the Dual Application Track

The Medicare-to-Medicaid transition runs on two parallel tracks:

The financial application goes to DWS through the myCase portal (jobs.utah.gov/mycase) or by fax. You'll need 60 months of bank statements, asset documentation, proof of income, and property records for both spouses.

The clinical assessment goes through the nursing facility's clinical team, who complete Form 927 verifying your parent meets the Nursing Facility Level of Care standard. Since your parent is already in a skilled nursing facility, this assessment is usually straightforward — the facility's own records document the level of care being provided.

Keep both tracks moving simultaneously. Form 927 is valid for 60 days from the level-of-care determination date, so if financial processing drags, you may need a new clinical assessment.

Our Utah Medicaid Long-Term Care & Asset Protection Guide includes a timeline tracker that coordinates both application tracks, helping you avoid the gaps and expired documents that delay the transition from Medicare to Medicaid.

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