Utah - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Utah, Homemaker Services provide essential general household support—such as meal preparation, laundry, shopping, and light housekeeping—to Medicaid Home and Community-Based Services (HCBS) waiver participants who are unable to perform these tasks themselves. These services are primarily delivered through the New Choices Waiver and the Aging Waiver, designed to help individuals maintain a safe and sanitary environment while remaining in their homes.

The single biggest structural barrier to entry for this service in Utah is the strict gatekeeping of waiver-specific contracting and certification. A provider cannot simply apply to be a Medicaid Homemaker agency; they must first secure a New Choices Waiver Provider Certification from the Division of Integrated Healthcare or win a contract through a Request for Proposal (RFP) with a regional Area Agency on Aging (AAA) before the state's Medicaid enrollment portal (PRISM) will even accept their application.

1. Service Definition and Scope

Homemaker services in Utah are defined as general household activities provided by a trained homemaker when the individual regularly responsible for these activities is temporarily absent or unable to manage the home. The service is strictly non-medical and non-hands-on.

The scope of the service is dictated entirely by the participant's person-centered care plan, which is developed by a state-authorized case management agency. Providers may only perform tasks explicitly authorized in this plan.

• Covered Tasks: Routine housecleaning, laundry, shopping for food and household supplies, and meal preparation.
• Excluded Services: Hands-on personal care (bathing, dressing, toileting), medical services, medication administration, and heavy chore services like moving furniture or snow removal.
• Applicable Waivers: Primarily authorized under the New Choices Waiver (NCW) and the Aging Waiver.
• Service Limits: Services are capped by the authorized hours in the care plan and cannot be provided if another capable household member is present and able to perform the tasks.

2. Regulatory and Oversight Agencies

Multiple divisions within the state government oversee HCBS providers in Utah. The specific oversight body depends on which waiver program the provider is contracted to serve.

Providers must comply with the rules of the overarching health department as well as the specific division managing their participants' waiver.

• Umbrella Agency: [Utah Department of Health and Human Services (DHHS)](https://dhhs.utah.gov/) serves as the primary state authority for Medicaid and HCBS licensing.
• Medicaid and NCW Oversight: [Division of Integrated Healthcare (DIH)](https://medicaid.utah.gov/) manages the Medicaid program and directly operates the New Choices Waiver.
• Aging Waiver Oversight: [Division of Aging and Adult Services (DAAS)](https://daas.utah.gov/) administers the Aging Waiver, delegating direct contracting to regional Area Agencies on Aging.
• Licensing Authority: [DHHS Office of Licensing (OL)](https://dhhs.utah.gov/office-of-licensing/) regulates and licenses human services and health facility providers across the state.

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah enforces strict structural preconditions that block applicants from enrolling in Medicaid as a Homemaker provider without prior authorization. Standalone Medicaid enrollment for this service does not exist.

Before accessing the Medicaid enrollment portal, an agency must successfully navigate the procurement or certification process of the specific waiver operating agency they intend to serve.

• New Choices Waiver Certification: To serve NCW participants, applicants must first apply for and receive a formal New Choices Waiver Provider Certification from the Division of Integrated Healthcare.
• Area Agency on Aging (AAA) Contracting: To serve Aging Waiver participants, providers must respond to and win a competitive Request for Proposal (RFP) or open enrollment contract directly with a regional AAA (e.g., Salt Lake County Aging & Adult Services).
• DSPD Request for Qualifications (RFQ): If attempting to provide similar supports under the Community Supports Waiver, providers must pass the Division of Services for People with Disabilities (DSPD) RFQ process and obtain a state contract.
• Business Registration: The agency must be legally registered and in good standing with the Utah Division of Corporations and Commercial Code before any waiver application is accepted.

4. Licensure and Certification Requirements

Utah does not issue a distinct "Homemaker Agency" license. Because pure homemaker services do not involve hands-on personal care or medical treatment, they do not strictly require a Home Health Agency license.

However, many agencies choose to obtain a Personal Care Agency license to offer a broader continuum of care, and all providers must meet federal HCBS settings requirements.

• Personal Care Agency License: Optional for pure homemaker services but common; governed by Utah Administrative Code R432-700 through the DHHS Office of Licensing.
• HCBS Settings Rule Compliance: Providers must complete the state's HCBS Settings self-assessment, training, and attestation to prove they deliver services in a non-institutional, community-integrated manner.
• Liability Insurance: Providers must maintain general liability and professional liability insurance as dictated by their waiver contract, typically requiring $1 million per occurrence and $3 million aggregate.
• Workers' Compensation: Agencies must provide proof of active workers' compensation coverage through the Utah Labor Commission.

5. Medicaid Provider Enrollment

Once the prerequisite waiver certification or AAA contract is secured, the agency must formally enroll as a Utah Medicaid provider. This process is handled entirely online.

Enrollment requires submitting the waiver approval documents alongside standard federal and state Medicaid disclosures.

• Enrollment Portal: All applications must be submitted through the [Provider Reimbursement Information System for Medicaid (PRISM)](https://medicaid.utah.gov/become-medicaid-provider/).
• Provider Type: Applicants must select the specific HCBS Waiver provider type designated by their certification (e.g., Provider Type 68 for New Choices Waiver).
• Application Fee: Providers are subject to the ACA institutional provider application fee (approximately $731) unless they provide proof of payment to Medicare or another state's Medicaid program.
• Required Attachments: Applicants must upload their W-9, waiver certification letter or AAA contract, business license, and proof of insurance directly into PRISM.

6. Staffing, Training and Background Checks

Utah strictly regulates the background and training of any staff entering a Medicaid participant's home. Clearances must be obtained through the state's centralized system before any client contact occurs.

Agencies are responsible for maintaining up-to-date personnel files that prove ongoing compliance with training and background requirements.

• Background Screening: All direct care staff must pass a fingerprint-based background check through the [DHHS Office of Background Processing (OBP)](https://dhhs.utah.gov/office-of-background-processing/) Direct Access Clearance System (DACS).
• Basic Qualifications: Homemaker staff must typically be at least 18 years old, possess a high school diploma or GED, and have the physical ability to perform household chores.
• Initial Training: Staff must complete CPR/First Aid certification and a waiver-specific orientation covering client rights, abuse reporting, and emergency procedures before serving clients.
• Ongoing Training: Agencies must provide and document annual in-service training on topics relevant to the waiver population they serve.

7. Documentation, Policies and Records

Providers must maintain comprehensive operational policies and client records that comply with both Utah Medicaid rules and federal HCBS standards.

Thorough documentation is the primary defense against Medicaid clawbacks during state audits or quality assurance reviews.

• Care Plan Adherence: Documentation must explicitly link the homemaker tasks performed during a visit to the goals and limits established in the participant's person-centered care plan.
• Service Logs: Agencies must maintain daily timesheets or Electronic Visit Verification (EVV) logs detailing the date, start and end times, and specific tasks completed.
• Incident Reporting: Policies must mandate the reporting of critical incidents (e.g., abuse, neglect, exploitation) to Adult Protective Services and the waiver case manager within 24 hours.
• Record Retention: Utah Medicaid requires all provider records, including personnel files and service logs, to be retained for a minimum of five years from the date of service.

8. Billing, Rates and Claims

Homemaker services are billed in 15-minute increments according to the fee schedule published by the specific waiver program. Claims are processed through the PRISM MMIS.

Providers cannot bill for services that exceed the authorized hours or for tasks performed outside the scope of the care plan.

• Billing System: Claims are submitted electronically via the [PRISM Portal](https://medicaid.utah.gov/become-medicaid-provider/) or through an approved clearinghouse using standard EDI 837P formats.
• Prior Authorization: 100% of HCBS homemaker services require prior authorization from the waiver case manager; claims submitted without a matching PA in PRISM will automatically deny.
• Procedure Codes: Services are typically billed using HCPCS code S5130 (Homemaker service, NOS, per 15 minutes), subject to the current Utah Medicaid fee schedule.
• Timely Filing: Claims must be submitted within 365 days of the date of service, though earlier submission is strongly recommended to resolve any PA discrepancies.

9. Approval Sequence and Timeline

Becoming a fully approved Homemaker provider in Utah is a multi-step process that requires sequential approvals from different state entities.

Providers should expect the entire process to take several months, with the waiver certification phase being the most time-consuming.

• Step 1: Business Formation: Register the agency with the Utah Division of Corporations and obtain necessary local business licenses (1-2 weeks).
• Step 2: Waiver Certification/Contracting: Apply to the specific waiver operating agency (e.g., New Choices Waiver or local AAA) and pass their readiness review (2-4 months).
• Step 3: Background Clearances: Register the agency in the DACS system and complete fingerprinting for all initial staff and owners (2-3 weeks).
• Step 4: PRISM Enrollment: Submit the Medicaid application with the waiver approval attached; PRISM processing typically takes 30-60 days.

10. Common Denials and Survey Findings

Applications and ongoing operations frequently face delays or corrective actions due to administrative errors or failure to follow waiver-specific rules.

Understanding these common pitfalls can help agencies avoid application rejection and maintain compliance during state audits.

• Premature PRISM Submission: Applying in PRISM before obtaining the required waiver certification letter results in immediate application rejection.
• DACS Non-Compliance: Allowing staff to provide services before their background clearance is fully approved in the DACS system is a critical survey violation.
• Inadequate Service Logs: Failing to document the specific homemaker tasks performed, or using generic notes, leads to Medicaid clawbacks during post-payment reviews.
• Missing Prior Authorization: Providing services before the case manager has officially entered the prior authorization into the PRISM system results in unpayable claims.

11. Key Contacts and Resources

Prospective providers must utilize official state resources to navigate the certification, licensure, and enrollment processes for Utah HCBS programs.

These portals and division websites contain the most current manuals, fee schedules, and application forms.

• Utah Medicaid Provider Enrollment (PRISM): [Become a Medicaid Provider - Medicaid - Utah DHHS](https://medicaid.utah.gov/become-medicaid-provider/)
• New Choices Waiver Program: [Division of Integrated Healthcare NCW Page](https://medicaid.utah.gov/ltc-2/nc/)
• Utah Division of Aging and Adult Services (DAAS): [DAAS Homepage](https://daas.utah.gov/)
• DHHS Office of Background Processing (DACS): [OBP Homepage](https://dhhs.utah.gov/office-of-background-processing/)

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