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 (persons who meet the eligibility requirements will receive services) and is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in New Jersey. More.
|2020 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||$2,349 / month*||$2,000||Nursing Home||$4,698 / month*||$3,000||Nursing Home||$2,349 / month for applicant*||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Help w/ 3 Activities of Daily Living||$4,698 / month||$3,000||Help w/ 3 Activities of Daily Living||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Help w/ 3 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$1,063 / month||$4,000||None||$1,437 / month||$6,000||None||$1,437 / month||$6,000||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.
When only one spouse of a married couple is applying for nursing home Medicaid or home and community based services via a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. That said, for Regular Medicaid (aged, blind & disabled), regardless if one spouse, or both spouses apply for benefits, the income of each spouse is counted towards eligibility. To learn more about what counts as income and how Medicaid counts income, click here.
In the case where just one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA) to which the non-applicant spouse is entitled.
As of July 2020, this minimum monthly amount is $2,155.00. (This figure is set to increase again in July 2021). In simple terms, this rule allows the Medicaid applicant to transfer income to the non-applicant spouse to bring his or her monthly income level up to $2,155.00. Shelter and utility costs are also considered, and based on these costs, the non-applicant spouse may be entitled to more than the base income allowance of $2,155.00. As of January 2020, the maximum monthly maintenance needs allowance is $3,216.00. (This figure will increase again in January 2021). This spousal income allowance is meant to ensure non-applicant spouses of nursing home Medicaid applicants and Medicaid waiver applicants have sufficient funds with which to live. This income allowance does not extend to non-applicant spouses of regular Medicaid applicants.
*As indicated in the chart above, to be eligible for nursing home Medicaid, there is an income limit. However, that doesn’t mean a beneficiary can retain income up to this level each month. This is because Medicaid-funded nursing home residents have to pay all of their income, minus a personal needs allowance of approximately $50.00 / month, and potentially an income allowance for a non-applicant spouse, to the nursing home.
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 specific conditions are met. To be exempt, the Medicaid applicant must live in the home or have “intent” to live there, and his / her equity interest in the home must not be greater than $893,000 (in 2020). (Equity interest equals the amount of the home’s value owned by the applicant). The home is also exempt, regardless of any other circumstances, if the applicant has a spouse living in it.
For married couples with one spouse as a nursing home Medicaid or Medicaid waiver applicant, there is a resource allowance. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). As of January 2020, the community spouse (the non-applicant spouse) can retain whichever is greater of the couple’s joint assets; $25,728 or 50% of the couple’s assets, up to a maximum of $128,640. (These figures will increase in January 2021).
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, aged, blind and disabled persons 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 applying for benefits. New Jersey has a six-month “spend-down” period, so once an individual (or couple) have paid their excess income down to the Medicaid eligibility limit for the period, they 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.
2) Qualified Income Trusts (QIT) – For persons applying for nursing home Medicaid or a HCBS Medicaid waiver who are over the income limit, yet still are unable to cover the costs of their long term care, QITs also called Miller Trusts, allows them to meet the income limit. In simplified terms, income over Medicaid’s income limit is deposited into a QIT and is not counted towards the income limit. A trustee is named, giving that person legal control of the money, and the funds in the account can only be used for very specific purposes, such as health insurance premiums and medical expenses that are not covered by Medicaid. The QIT must be irreversible, meaning once it has been established, it cannot be changed or canceled. In addition, the state of New Jersey must be listed as the beneficiary upon the death of the Medicaid recipient.
Unfortunately, the Medically Needy Pathway nor Miller Trusts assist one in spending down extra assets in order to qualify for Medicaid. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the Medically Needy program cannot help one reduce their extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, 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.
3) 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 persons in their homes can be both less expensive than nursing home care and is preferable for the care recipients and their families. 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”. Beneficiaries can choose their own care providers and they can hire their family members as care providers.
How to Apply for New Jersey Medicaid
In New Jersey, seniors can apply for FamilyCare Aged, Blind, Disabled Programs online at NJFamilyCare, complete a printed application and return it to one’s county welfare agency, or call 1-800-701-0710 to apply over the phone. Persons can also contact their county welfare agency for program questions and application assistance. In addition, the Area Agency on Aging office in one’s area may be helpful in answering program questions and providing assistance with the application process.
It is important to mention that applying for Medicaid in New Jersey isn’t always as straightforward as one might think. This is partly because there are several programs relevant to aging seniors and partly because it is vital that applicants are certain that they meet the eligibility criteria (discussed above) prior to submitting an application for benefits. Seniors who have income and / or assets greater than the allowable amount(s) should strongly consider Medicaid planning. This can make the difference between acceptance into a Medicaid program and the denial of benefits. To learn more about the application process for long-term care Medicaid, click here.