Utah Medicaid waiver bathroom modifications: Aging Waiver vs New Choices Waiver

Updated November 8, 2026. Program rules are from the Utah Department of Health and Human Services fact sheets and the New Choices Waiver provider attachment for code S5165, read on that date. This page supports our guide to paying for a walk-in tub in Utah, which covers VA, USDA and Area Agency on Aging options too. Programs may help; none guarantees payment.

Which Utah waiver covers bathroom modifications?

Utah runs nine Medicaid 1915(c) home and community-based waivers. Two of them matter for an older adult's bathroom, and they serve different people. The quickest way to tell which one applies is to ask where the person lives today.

Sources: Utah DHHS fact sheets for the Waiver for Individuals Age 65 or Older (updated November 2022) and the New Choices Waiver, and the New Choices Waiver Attachment B for Environmental Accessibility Adaptations (version July 1, 2016).

What does the Environmental Accessibility Adaptations service cover?

The New Choices Waiver attachment is the most detailed public description Utah publishes. It defines the service as equipment or physical adaptations to the person's residence that are necessary to assure health, welfare and safety, or that let the person function with greater independence at home. The adaptations have to be identified in the person's care plan, with the model and type specified by a qualified individual, and the work must follow state and local building codes. The list of what may be included is short:

1. Ramps
2. Grab bars
3. Widening of doorways and hallways
4. Modifications of bathroom facilities
5. Modifications of kitchen facilities
6. Modification of electric and plumbing systems

Purchase, installation and repairs are all allowed, and the attachment says other adaptations may be approved case by case as needs or technology change. A walk-in tub or a roll-in shower falls under "modifications of bathroom facilities," and the plumbing and electrical work they need falls under item six. That is as specific as the state gets in writing. Whether a particular tub is approved depends on the assessment, the care plan and the case management agency.

What the documents do not say matters too. There is no published exclusion list and no published dollar cap for S5165. In practice the service exists to remove barriers, so expect the case manager to approve the accessible feature itself (the low threshold, the seat, the grab bars, the hand shower, the plumbing to make it work) and to question anything that reads as a remodel or a comfort upgrade. Hydrotherapy jets, heated seats and tile work are the items most likely to be left to the family. If a feature matters to you, ask before the authorization is written, not after.

Who is allowed to do the work?

This is where many families get stuck. The waiver does not reimburse you for a contractor you found; it pays an enrolled provider directly. Under the S5165 attachment a provider must have a current business license, be enrolled with Utah Medicaid specifically to provide Environmental Accessibility Adaptations, be able to perform the tasks the case management agency orders, and, for installers and repair people, hold a contractor's license. New providers must also complete the New Choices Waiver provider training before enrollment is finished.

The same attachment sets the money rules. The provider accepts the Medicaid rate as payment in full and may not bill the client or the family an additional fee for the authorized work. No work can start until a service authorization has been signed by both the case management agency and the provider; authorizations run for at most one year; and claims outside the authorized dates, units or codes are recovered. Providers are also barred from direct marketing to prospective waiver clients and from paying incentives to case managers, which is why you will not see waiver work advertised the way walk-in tubs usually are.

Utah's separate licensing law applies on top of this. Replacing a tub means disconnecting and reconnecting plumbing, which Utah Code 58-55-305 reserves for a licensed plumbing contractor even on small jobs. Our Utah installation guide explains the rule and how to check a license with DOPL in about a minute.

How do you apply, step by step?

1. Pick the waiver by where the person lives. At home and 65 or older: Aging Waiver. In a nursing facility, hospital or assisted living and planning to move home: New Choices Waiver. People who are not living in one of those facilities cannot apply to New Choices.
2. Make the first call. Aging Waiver referrals go through your local Area Agency on Aging, listed on our paying guide, or the Division of Aging and Adult Services at 801-538-3910. New Choices applications are available at medicaid.utah.gov/ltc-2/nc/ or by calling 801-538-6155, option 6.
3. Get the two determinations. A nursing-facility level-of-care assessment and a Medicaid financial eligibility decision. Both must be in place before enrollment.
4. Wait for a slot if you are told to. The Aging Waiver has a waiting list. Ask the agency how placement works and whether a change in health or living situation should be reported.
5. Work with the case manager on the care plan. The bathroom change has to be written into the plan as necessary for health, welfare, safety or independence. A letter from a physician or occupational therapist describing the need is the document that usually carries the decision.
6. Let the case management agency issue the service authorization to an enrolled, licensed provider. Only then does installation get scheduled.

Aging Safely Baths writes the itemized estimate and product specifications a case manager asks for, and can tell you whether an installer in your area is enrolled. For the national picture on how state waivers treat walk-in tubs, see Aging Safely Baths' state-by-state Medicaid and walk-in tub guide.

What changed in 2026?

In May 2026 the state posted waiver amendments funded by SB288. The executive summary describes rate increases in both the Aging Waiver and the New Choices Waiver for personal care, adult day health, attendant care, homemaker, respite, transportation and, in New Choices, habilitation and adult residential services. It does not mention Environmental Accessibility Adaptations, so the home modification service and its 2016 provider attachment were unchanged by that round. Higher rates for daily services can still matter to a bathroom project indirectly, because a waiver that keeps someone safely at home is the reason the modification gets approved in the first place.

What should a family realistically expect?

Three things. First, time: enrollment, assessment and authorization come before any tub is ordered, and the Aging Waiver adds a waiting list. If a fall risk is immediate, families often pay for grab bars or a transfer bench now and pursue the waiver for the larger change. Second, a defined scope: the authorization will say what is paid for, and the provider cannot bill you for extras, so anything outside the scope is a separate private purchase arranged in advance. Third, no guarantee: the waiver pays for what the assessment says is needed, which may be a roll-in shower rather than a tub, or grab bars rather than either.

What a quote for a Utah bathroom includes, and which items are the accessibility pieces a case manager will recognize, is covered in our Utah walk-in tub cost guide. If you want a written estimate to take to a case manager, request one here or call 1-888-779-2284. No bathing product eliminates the risk of falls; products are designed to reduce risk when installed and used properly.

Questions families ask

Does Utah Medicaid pay for a walk-in tub?

Not as a regular Medicaid benefit. Two of Utah's 1915(c) waivers, the Aging Waiver and the New Choices Waiver, list Environmental Accessibility Adaptations, which can include modifications of bathroom facilities when a case manager finds them necessary for health, welfare and safety or for greater independence. Whether that is a walk-in tub, a roll-in shower or grab bars is decided in the care plan, not by the applicant. A waiver may help; it is not a guarantee.

What is the difference between the Aging Waiver and the New Choices Waiver?

The Aging Waiver serves Utahns 65 and older who live at home and need nursing-facility level of care; it has a waiting list and is reached through your Area Agency on Aging or the Division of Aging and Adult Services. The New Choices Waiver serves adults 18 and older who are already living long term in a nursing facility, hospital or licensed assisted living and want to move to a home setting. You apply to the waiver program office directly.

Is there a dollar limit on Utah waiver home modifications?

The published New Choices Waiver service attachment for code S5165 does not state a dollar cap, and neither waiver fact sheet publishes one. The limit in practice is the care plan: you receive only the adaptations you are assessed to need, authorized in writing before work starts. Ask the case manager whether any internal cost threshold or bid requirement applies to your project.

Can I hire my own contractor for a waiver bathroom modification?

Only if that contractor is enrolled as a Utah Medicaid provider for Environmental Accessibility Adaptations and holds a Utah contractor's license. The provider must also accept the Medicaid rate as payment in full and cannot bill you or your family extra. A contractor who is not enrolled cannot be paid by the waiver, so ask early and expect the case manager to work from the enrolled provider list.

How long is the wait for the Utah Aging Waiver?

The state fact sheet says plainly that there is a waiting list and that a limited number of individuals are served, but it does not publish a typical wait time, and waits vary by region and by how urgent the assessment finds your situation. Call your Area Agency on Aging to be assessed and placed on the list, and ask them what they are seeing locally. The New Choices Waiver says it does not expect to exceed its participant cap.

Who do I call to start a Utah waiver bathroom modification?

For the Aging Waiver, your local Area Agency on Aging, or the Division of Aging and Adult Services at 801-538-3910. For the New Choices Waiver, the program office at 801-538-6155, option 6, or 1-800-662-9651, option 6, from outside Salt Lake. The modification itself starts only after enrollment, an assessment, and a signed service authorization from your case management agency.