New Jersey Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal health care program for individuals with limited income and resources, and is intended to assist individuals of all ages. However, this page is focused strictly on long-term care Medicaid eligibility for New Jersey elderly residents who are 65 years of age and older. (Long-term care may be received in the individual’s home, an assisted living residence, or a nursing home). In the state of New Jersey, Medicaid for the elderly is also referred to as the NJ FamilyCare Aged, Blind, Disabled (ABD) Programs. The New Jersey Department of Human Services, Division of Medical Assistance and Health Services administers these programs.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which New Jersey seniors may be eligible. These programs have slightly different functional and financial eligibility requirements, as well as program benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that New Jersey offers several pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants, which means waiting lists may exist. Services provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement and is provided at home or adult day care.
As stated above, eligibility for these programs is complicated by the facts that the criteria vary with marital status and that New Jersey offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from a Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 New Jersey Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$3,375 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Help w/ 2 ADLs||$3,375 / month||$3,000||Help w/ 2 ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w/ 2 ADLs|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$4,000||None||$1,372/ month||$6,000||None||$1,012 / month||$4,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $858,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
One important consideration when applying for Medicaid is New Jersey’s 5-year Medicaid Look-Back Period. This is a period of 5 years prior to one’s Medicaid application in which Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For elderly New Jersey residents, 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills. In New Jersey, this program is called the Medically Needy Program or the Special Medicaid Program, Medically Needy Segment. Also commonly referred to as a “Spend down” program, one’s “excess income,” (the amount of income over the Medicaid eligibility limit), is used to cover medical bills and health insurance premiums. The monthly income limit for the Medically Needy Pathway is different from the other income limits listed above. Currently, the monthly income limit for the Medically Needy program is set at $367 for an individual and $434 for a married couple with both spouses applying for benefits. New Jersey has a six-month “spend-down” period, so once an individual has paid their excess income down to the Medicaid eligibility limit for the period, one will qualify for the remainder of the six-month period. The asset limits for Medicaid qualification via the Medically Needy Pathway are the same as those listed above for Regular Medicaid / Aged Blind and Disabled: $4,000 for a single individual and $6,000 for a married couple in which both spouses are applying.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets in order to qualify for Medicaid. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the Medically Needy program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications, like the addition of wheelchair ramps, roll in showers, or stair lifts, prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific New Jersey Medicaid Programs
New Jersey, like most states, pays for nursing home care but also recognizes that providing care for a person in their home can be both less expensive than nursing home care and preferably for the care recipient and their family. Under the state’s Managed Long Term Services & Supports (MLTSS) program, financially and medically qualified persons can receive a variety of care services in their homes or in assisted living residences. Benefits such as personal care, adult day care, home modifications and medical alert services are provided.
Another NJ Medicaid option of interest is the Personal Preference Program (PPP). PPP benefits include assistive technologies, home modifications and personal care. Most interestingly, personal care can be “self-directed”. The beneficiary can choose their own care provider and they can hire their family members as care providers.