When it comes to long-term care services, Medicaid is a crucial resource for many New Jersey residents. This is especially true considering the high cost of long-term care in the Garden State.
As you may already know, Medicaid is a federal and state-funded program that provides assistance to low-income individuals and families who need help paying for medical care. What you may not know, however, is that New Jersey offers special services to individuals who require long-term care. This is known as Managed Long Term Services and Supports, or MLTSS for short.
This article will walk you through New Jersey’s MLTSS offerings, how to qualify, and how an experienced New Jersey Medicaid attorney can help you get the coverage you need.
New Jersey’s MLTSS Program
MLTSS provides long-term services to residents of the Garden State through NJ FamilyCare, New Jersey’s Medicaid agency. The services provided by MLTSS are available to those who require significant assistance with activities of daily living, whether you live in a nursing home, an assisted living facility, or at home.
In addition to all of the services provided by NJ FamilyCare Plan A, MLTSS also provides care management, vehicle and home modifications, meals, the costs of living in a long-term care facility, and more.
Qualifying for MLTSS in New Jersey
To qualify for MLTSS in New Jersey, an individual must meet certain financial and medical requirements. Financial requirements include income and asset limits, while medical requirements include a demonstration of medical need for long-term care services.
Like other Medicaid programs, to qualify for MLTSS, you must be a United States citizen or legal permanent resident. Further, you must live in New Jersey and have no intention of leaving.
Required Health Status
Individuals 21 years or older can meet the MLTSS medical eligibility requirements if they require hands-on assistance with at least three daily living activities, such as bathing, dressing, toileting, eating, bed mobility, or other activities. Individuals who are 20 years or younger can also qualify by demonstrating developmental delay or functional limitations for activities of daily living.
To meet the medical requirements, you need to complete a Pre-Admission Screening to see if you are clinically eligible. If you already live in a nursing home or assisted living facility, write to the business office of your facility to request this screening. Be sure to do this at least 30 days prior to your anticipated date of eligibility. If you live at home, you or a loved one must call the county Area Agency on Aging to be screened for services.
To qualify for MLTSS in New Jersey, you must meet certain income requirements, which change annually. Unlike other Medicaid programs, there is no countable income and non-countable income. For MLTSS, income is defined as “anything you receive in cash or in kind that you can use to meet your needs for food and shelter.”
Beginning in 2014, New Jersey jettisoned the Medically Needy program in favor of the use of Qualified Income Trusts. Qualified Income Trusts help you to qualify for MLTSS despite exceeding the income requirement. For more information on Qualified Income Trusts, be sure to check out our article.
Additionally, for married individuals, you can use the minimum monthly maintenance needs allowance (“MMMNA”) for post-eligibility income deduction. The MMMNA is an amount of money that can be deducted from the institutionalized spouse’s income should the non-institutionalized spouse make less than the MMMNA amount. From July 1, 2023 through June 30, 2024, this amount is $2,465.
We understand that understanding these income requirements can be confusing. Hence, it is crucial to work with a local New Jersey Medicaid attorney when applying for MLTSS to make sure your income is properly calculated.
Meeting the Asset Limit
For individuals seeking long-term care assistance through New Jersey Medicaid, it is important to also be aware of the asset limits that determine eligibility. As of 2023, the asset limit for an individual applying for Medicaid long-term care services is set at $2,000.
For married couples, the asset rules are more complex. For couples, not only is the institutionalized spouse subject to an asset limit, but the non-institutionalized spouse is also subject to an asset limit. Inventorying and valuing assets can be a daunting process, but an attorney can help you with this arduous process.
Types of Long-Term Care Settings
Besides qualification requirements, another important consideration for MLTSS is what kind of long-term care setting you prefer. There are a number of different options available depending on your location and needs. These options include nursing homes, assisted living facilities, and home health care.
Nursing Home Care
For many individuals who require long-term care, nursing home care is a necessary option. Medicaid in New Jersey covers nursing home care for eligible individuals who require around-the-clock skilled nursing care.
Assisted Living Facilities
Assisted living facilities can be a great option for individuals who need some assistance with daily tasks but do not require the around-the-clock care provided in a nursing home.
Medicaid in New Jersey covers assisted living services for eligible individuals. Assisted living services can include assistance with activities of daily living, medication management, and other services that are necessary for an individual’s health and well-being.
Home Health Care
Many individuals prefer to receive long-term care services in their own homes. MLTSS in New Jersey also covers home health care for eligible individuals. Home health care services can include nursing care, physical therapy, occupational therapy, and other services that are necessary for an individual’s health and well-being.
If you are approved for Personal Care Assistant Services and are able to self-direct services, you can take advantage of the Personal Preference Program (PPP). Individuals utilizing PPP can choose the home care services they want, hire workers that they know and trust, including friends, relatives, or neighbors, and schedule services according to their individual needs.
A Crucial Point on Long-Term Care
It is important to note, however, that while these care options may be available through MLTSS, many nursing homes in New Jersey require six (6) months of private pay before considering taking it as a form of payment. Assisted living facilities frequently require two (2) years of private pay. And, in-home care may not be viable because the care hours will be limited.
How An Attorney Can Help
Applying for Medicaid can be a complex process. Luckily, an experienced New Jersey elder law attorney can help you with the application process by ensuring that you apply for the benefits that you need, navigating complicated legal provisions to protect family assets, and protecting your rights. Additionally, hiring an attorney can save time and help avoid costly penalties.
Luckily, The Chamberlain Law Firm is here to help. If you have any questions or are ready to begin the MLTSS application process, give us a call at (201) 273-9763 for a free consultation. For more Medicaid advice, be sure to read some of our Insight Articles.
This article is for informational purposes only. It is not intended as legal advice. In the event you would like to speak with a lawyer about the specifics of your case, contact The Chamberlain Law Firm at (201) 273-9763 to schedule a consultation.