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Utah - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Utah funds tenancy support through the Housing Related Services and Supports (HRSS) program under the state's 1115 Demonstration Waiver, targeting members in the Targeted Adult Medicaid (TAM) and Adult Expansion Medicaid (AEM) populations.

Approval to bill for these services requires providers to secure network contracts with Utah's Accountable Care Organizations (ACOs), such as SelectHealth, before rendering services. Agencies must enroll through the PRISM system and ensure all case managers hold either a specific Utah Department of Health and Human Services (DHHS) certification or an active social work license.

1. Service Definition and Scope

In Utah, Tenancy Support Services are a core component of the HRSS program. These services are designed to help vulnerable Medicaid members secure and maintain stable housing in the community.

The scope of the service includes tenant screening, developing individualized housing support plans, assisting with housing applications, eviction reduction, and helping members navigate housing vouchers and recertifications.

2. Regulatory and Oversight Agencies

The Utah Department of Health and Human Services (DHHS) oversees the HRSS program through its Division of Integrated Healthcare. Within this division, the Office of Long Term Services and Supports (OBLTSS) directly manages the housing waiver components.

Providers must also interact with the state's managed care entities, known as Accountable Care Organizations (ACOs), which administer benefits for the TAM and AEM populations.

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not operate HRSS as a purely fee-for-service open network. Providers must successfully execute independent credentialing applications and secure network contracts with Utah's ACOs.

Additionally, agencies cannot be approved to provide this service unless their direct-care staff already meet strict professional licensing or state certification requirements prior to enrollment.

4. Licensure and Certification Requirements

Utah does not issue a distinct facility or agency license specifically for "Housing Stabilization" or HRSS providers. Instead, the state relies on individual professional licensure and Medicaid provider enrollment standards.

Agencies must ensure that the individuals delivering the tenancy support hold the required social work licenses or the specific DHHS Case Manager Certification.

5. Medicaid Provider Enrollment

Agencies must enroll as Utah Medicaid providers using the PRISM (Provider Reimbursement Information System for Medicaid) portal. The system requires comprehensive ownership disclosures and proof of a physical location.

Providers must complete the specific enrollment packets designated for waiver and HRSS services, ensuring all staff credentials are uploaded.

6. Staffing, Training and Background Checks

Direct service staff providing tenancy support must meet strict qualification standards set by OBLTSS. Background checks are mandatory and processed through the state.

Providers must also connect with the HRSS team for mandatory provider education regarding the specific requirements of this 1115 waiver program.

7. Documentation, Policies and Records

Providers must maintain detailed records demonstrating the member's clinical and social risk factors. This includes documenting homelessness or the risk of homelessness according to federal HUD definitions.

Every member must have an individualized housing support plan and a housing crisis plan on file.

8. Billing, Rates and Claims

HRSS services are billed using specific HCPCS codes outlined in the Medicaid General Information Manual and HRSS provider notices. Because these members are managed by ACOs, claims are typically routed through the managed care plans.

Providers utilize the Utah Health Information Network (UHIN) for electronic claims submission and clearinghouse services.

9. Approval Sequence and Timeline

The approval process is sequential, beginning with ensuring all direct-care staff hold the required licenses or DHHS certifications. Without these, the agency cannot proceed.

Once staff are credentialed, the agency applies through PRISM, completes HRSS provider education, and finally seeks network contracts with the ACOs.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied in PRISM due to missing staff credentials or incomplete ownership disclosure forms.

During audits or claims processing, denials often occur if the provider fails to verify the member's specific TAM or AEM eligibility on the date of service, or if room and board costs are improperly billed.

11. Key Contacts and Resources

The primary contacts for the HRSS program are within the OBLTSS housing team, who handle provider education and program-specific inquiries.

General Medicaid enrollment questions should be directed to the Provider Enrollment unit.

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