New Jersey Medicaid Rules for Long-Term Care

New Jersey’s state-run Medicaid program can provide comprehensive long-term care benefits for individuals who are blind, disabled, or over the age of 65 and who also meet the financial level of need as well as criteria for the needed level of care. 

Medicaid’s benefits and offerings sound generous, but they are designed only for individuals who can demonstrate that they cannot pay for the care themselves. However, with careful planning, individuals can protect their assets from long-term care costs and qualify for Medicaid without having to sell all their property. 

Put simply: Medicaid long-term care services aren’t free. Individuals seeking benefits under Medicaid have a strong motivation to work with an experienced elder law attorney in New Jersey who is familiar with strategies for Medicaid assets protection. DMAHS sets stringent criteria that include monthly income limits and a requirement to liquidate all non-exempt property in order to apply its value towards the costs of long-term care. DMAHS also has the right to estate recovery, meaning that the division can place a lien on real property and have the right to claim portions of an estate after the care recipient’s death. 

Arranging assets in a certain way can frequently allow households to meet Medicaid eligibility rules, and can help protect certain assets from estate recovery after the recipient’s death.

For more information on Medicaid rules for long-term care and Medicaid assets protection in New Jersey, schedule a no-obligation consultation with Van Dyck Law Group today. Call (609) 293-2621 or contact us online to schedule your appointment today!

What Services and Benefits Are Offered as Part of Medicaid Long-Term Care in New Jersey?

Medicaid long-term care in New Jersey is referred to as Managed Long Term Services and Supports (often referred to by the more general term “Medicaid”). The program is provided through New Jersey Medicaid’s NJ FamilyCare managed care program, and it can support individuals who require long-term care, according to their individual needs. That support may be care at home, residency at a nursing home or assisted living facility, or access to community residential services.

The New Jersey Division of Medical Assistance and Health Services (DMAHS) states that the purpose of Medicaid long-term care is to “expand home and community-based services, promote community inclusion and ensure quality and efficiency.”

Some of the specific offerings include:

  • Access to all NJ FamilyCare Plan A Benefits
  • Care Management
  • Home and Vehicle Modifications
  • Home Delivered Meals
  • Respite
  • Personal Emergency Response Systems
  • Mental Health and Addiction Services
  • Assisted Living
  • Community Residential Services
  • Nursing Home Care

Eligible individuals can receive care at a qualifying facility, through in-home support, or via services like transport to medical appointments.

How to Apply for Long-Term Care through Medicaid in New Jersey

Conveniently, one can begin the application process while seeking information at the same time. You can call our office to set up a consultation, and we can advise you on whether Medicaid planning is the right choice for you. Alternatively, an individual looking to start the process can call their local county’s Area Agency on Aging (AAA) and ask to speak to the Aging and Disability Resource Connection (ADRC). Someone at the ADRC can provide you with information and answer any questions you have. If you are interested in applying to Medicaid or another related program, the ADRC will perform a screening questionnaire.

The questionnaire covers specific questions about the applicant’s daily routine, the tasks they need assistance with, and other medical and personal needs. Once the screening has been completed, the information will be submitted to NJ FamilyCare, who will contact you in order to continue the screening process.

As part of the process, applicants need to not only provide medical documentation but also statements regarding income and certain assets. NJ FamilyCare provides a convenient checklist detailing the income and resources documentation they require.

What Are the Medicaid Long-Term Care Eligibility Rules in New Jersey?

There are two main eligibility areas where applicants must meet specific criteria: level of financial need, and needed level of care.

Financial Eligibility Criteria for Long-Term Medicaid Benefits in New Jersey

To determine financial eligibility, NJ FamilyCare’s Eligibility Determining Agency reviews all income, assets, living expenses, and other documentation to determine if you lack the resources needed to pay for long-term care yourself.

Eligibility is determined both by current monthly income and by the value of assets you currently have available that could theoretically be sold in order to pay for care. Monthly income limits for Medicaid in New Jersey fluctuate; they were $2,313 per month for individuals and $4,626 per month for couples as of 2019.

Medical Support Level of Need Criteria

Medicaid eligibility is only available to individuals who are 65 and older or individuals who are blind/disabled. For more information on eligibility for disabled or blind individuals 64 and under, visit the DMAHS information page.

For individuals 65 and older, they must still have a demonstrated need for one or more of the benefits offered by Medicaid. DMAHS provides that someone may qualify if, “the individual requires hands-on assistance with three or more activities of daily living such as bathing, dressing, toileting, locomotion, transfers, eating, and bed mobility or has cognitive deficits and requires supervision and cueing with three or more activities of daily living.”

SSI Recipients Are Automatically Eligible

If you are currently receiving Supplemental Security Income (SSI), you will be determined to automatically qualify for Medicaid in New Jersey.

Medicaid Assets Protection in New Jersey

There are two primary areas of concern when it comes to asset protection for Medicaid long-term care benefits: assets/income that could affect eligibility and assets held in the estate after the care recipient’s death.

Reducing Assets and Income to Meet the Level of Financial Need

Whether by design or as an unintended side effect, Medicaid income and asset limitation rules encourage households to spend down assets in order to qualify. Meaning, Medicaid on its face requires that you use up all of your resources paying for long-term care before you will be entitled to government benefits to cover those costs on your behalf. This can leave the household without the resources needed to provide for basic necessities, particularly for the spouse who does not require Medicaid and any dependents.

Fortunately, there are programs and exemptions available to protect the ability of the household to maintain its living costs and keep up with expenses. One option is to establish a fund with a specific annuity that would be exempt from income limits set by Medicaid. Another method, if there is a child who has provided care, is to use a special Medicaid rule exception for child care-givers that allow assets to be protected from long-term care costs. This second exception is very fact-specific – speak to our office and we can advise you on whether it applies to you and if so, how to prove that.

Importantly, individuals cannot simply shed resources by giving them away, either. Medicaid uses a five-year lookback period to determine when resources have been quickly spent or gifted in a clear effort to reach qualification criteria.

Van Dyck Law Group provides assistance to individuals looking to qualify for Medicaid long-term care coverage and New Jersey Medicaid waiver programs and who are in need of guidance for the best way to arrange their finances. We can examine your specific circumstances and provide suggestions for a long-term care plan to most effectively help you reach income criteria while still being able to provide for the household through annuities and other forms of exempt income.

Qualified Income Trust (QIT)

NJ FamilyCare allows for the creation of a dedicated bank account known as a QIT where all monthly income past the current eligibility limit can be deposited in order to allow the individual to remain eligible. See the DMAHS website for more information, and refer to a New Jersey Medicaid eligibility lawyer for any questions or assistance.

Asset Protection Against Medicaid Estate Recovery in New Jersey

Many individuals are surprised to learn that participation in certain Medicaid programs after the age of 55 can allow the state to recover some or all of the money spent on the individual after their death. The most common method is for the state to place a lien on a home, and when the home is sold the state will recover a portion of the sale’s proceeds. The state may also seek the value of some of the estate following the care recipient’s death.

Estate recovery is delayed so long as at least one of the following is true:

  1. The deceased has a surviving spouse
  2. The deceased has one or more surviving children under age 21
  3. The deceased has a surviving child who is blind or permanently and totally disabled, according to Social Security standards

The state may also choose to not pursue estate recovery in instances where the cost of doing so would exceed the financial gains, or when property in the estate acts as the sole source of income for a survivor, meaning to remove said property would make the individual qualify for public assistance and/or Medicaid benefits.

It is often recommended by individuals in the ADRC and NJ FamilyCare to speak to an elder law attorney in New Jersey who can help applicants determine ways to transfer property they wish to protect from estate recovery in a legitimate way. Our office can help guide you. Estate recovery has a five-year lookback period, just like financial need screening, so individuals must be careful not to perform actions that could trigger penalties or arouse suspicion of fraud.

Speak to a New Jersey Elder Law Attorney About Medicaid Eligibility Rules and Assets Protection

Qualifying for Medicaid is a major boon for individuals and families struggling with long-term care needs. Without proper planning based on available resources, long-term care can easily exhaust the entirety of a household’s savings. Exploring your options for Medicaid assistance and speaking with an experienced attorney familiar with state rules can increase the chances that you are able to receive the needed care without jeopardizing your family’s financial future.

Schedule your confidential, no-risk case evaluation and consultation now when you call Van Dyck Law Group at (609) 293-2621 or contact us online.

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