Overview of Personal Preference Program / Personal Care Assistant Services
New Jersey’s Personal Preference Program (PPP) is a participant-directed program for NJ FamilyCare (Medicaid) beneficiaries who are elderly or disabled and require personal care assistance. Via PPP, participants are allotted a monthly budget to manage their own long-term care. Working within their budget, program participants can hire the caregiver of their choosing, pay for home modifications, and purchase assistive technology to promote independent living. An alternative to agency provided services, PPP allows program participants more flexibility and choice when it comes to the services and supports they require to live at home.
PPP beneficiaries can hire a friend or relative (including their spouse) to provide Personal Care Assistant (PCA) services. PCA services include in-home assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs and IADLs include personal hygiene, bathing, dressing, using the toilet, eating, preparing meals, housecleaning, and laundry. A financial management services agency handles the financial aspects of employment responsibilities, such as assistance managing one’s budget, tax withholding, and caregiver payments.
While it is required that one be able to self-direct their own care, persons who have limited cognitive ability, such as those with Alzheimer’s Disease or a related dementia, can choose a representative to make decisions on their behalf. The representative can be a family member or friend, but not the same individual who is hired to provide care.
PPP program participants can live their own home, the home of a loved one, or a congregate setting (given PCA services are not provided). They cannot live in an assisted living residence or an adult foster care home.
The Personal Preference Program / State Plan Personal Care Assistant Services is an entitlement. This means the number of participant enrollment slots are not limited and there is never a waitlist for program participation. Persons who meet the program and service requirements are able to participate in PPP without a delay.
Personal Care Assistant Services are a benefit available via New Jersey’s State Plan Medicaid program. Medicaid in New Jersey is called NJ FamilyCare and the programs specific to seniors and disabled individuals are called Aged, Blind, Disabled (ABD) Programs. NJ FamilyCare benefits are delivered via a managed care delivery system. The Personal Preference Program is authorized under the 1915(j) State Plan Option, which allows Medicaid beneficiaries to self-direct their PCA services. NJ Medicaid also offers agency based Personal Care Assistant Services via the Medicaid State Plan. State residents are not required to receive PCA Services via the Personal Preference Program.
Participant-directed care may also be called self-directed care or consumer-directed care. In Medicaid-speak, it is commonly called “Cash & Counseling”. With participant-directed care, program participants are allotted a budget and given freedom to select long-term services and supports to assist them in living independently. Most popular is the option to hire the caregiver of their choosing to provide assistance, such as personal care and homemaker services. Friends and relatives, including adult children, are commonly able to be hired. Furthermore, it is becoming increasingly common that one’s spouse can be hired as the caregiver.
Benefits of Personal Preference Program / Personal Care Assistant Services
PPP program participants are allotted a monthly budget. This is calculated using the number of authorized personal care assistant service hours based on an assessment of care needs. Follows are examples of ways in which funds may be used.
– Hiring a caregiver, including family, such as one’s spouse, adult child, grandchild, and niece / nephew, to provide personal assistant services. This includes assistance with bathing, dressing, grooming, using the toilet, eating, transferring (i.e., from a bed to wheelchair), meal preparation / clean-up, light housecleaning, laundry, and shopping for essential items, such as groceries.
– Purchasing assistive technology, appliances, electronic devices, or other goods that allow a program participant to be more independent. (i.e., a front loading washing machine for wheelchair accessibility)
– Home modifications for safety and accessibility (i.e., grab bars, wheelchair ramps)
– Vehicle modifications for accessibility
– Adult Day Care
– Respite Care – to relieve a primary caregiver
– Cleaning Services – hiring a private company
– Laundry Services – i.e., laundromat
– Errand Services – i.e., assistance with banking, shopping for essentials
Eligibility Requirements for Personal Preference Program / Personal Care Assistant Services
The Personal Preference Program is for New Jersey residents enrolled in NJ FamilyCare Plan A (Medicaid), require personal care assistant services, and can self-direct their own care. While various groups of persons can qualify for NJ FamilyCare Plan A, eligibility for those who qualify for Aged, Blind, Disabled (ABD) Medicaid through NJ’s State Plan Medicaid program is covered below.
Financial Criteria: Income, Assets & Home Ownership
Income
In 2024, a single applicant can have a monthly income up to $1,255 / month. Married applicants, regardless of if one spouse or both are applicants, are limited to $1,704 / month in income. These income limits are equivalent to 100% of the Federal Poverty Level (FPL) for a household of one and a household of two.
Assets
In 2024, the asset limit is $4,000 for a single applicant. For married couples, with one or both spouses as applicants, the asset limit is $6,000.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month Look-Back Rule during which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, this is not relevant for State Plan Personal Care Assistant Services.
Home Ownership
The home is often the highest valued asset a New Jersey Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “Intent” to Return, and in 2024, their home equity interest is no greater than $1,071,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor, blind, or disabled child living in the home.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must be eligible for personal care assistant services. This means that hands on assistance with Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, bathing, toileting, eating) is required. Furthermore, the need for Personal Care Assistant Services, which must extend for 6 months or longer, must be documented by a doctor. Persons with Alzheimer’s disease or a related dementia may be eligible for PCA Services / PPP, but a diagnosis of dementia in and of itself does not mean one will automatically meet the functional need.
Qualifying When Over the Limits
Having income and / or assets over NJ FamilyCare’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Utilizing Miller Trusts, often called Qualified Income Trusts, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. Miller Trusts, unfortunately, are not permitted for applicants to become income-eligible for New Jersey’s State Plan Personal Care Assistant Services / Personal Preference Program.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. These are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. For married persons with a significant amount of “excess” assets, a Medicaid Divorce can protect assets for the non-applicant spouse. Persons can also “spend down” assets on medical bills, household furnishings and appliances, or even a vacation. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in New Jersey to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some planning strategies serve the dual purpose of helping one meet Medicaid’s financial criteria and protecting assets from Medicaid’s Estate Recovery Program. If assets are not protected from Estate Recovery, Medicaid attempts to be reimbursed for long-term care costs from any remaining assets after the Medicaid recipient’s death.
While Medicaid’s 60-month Look-Back Rule does not apply for State Plan Personal Care Assistant Services / Personal Preference Program, it does apply to Nursing Home Medicaid and NJ’s Medicaid Managed Long-Term Services and Supports Program. As more extensive care might be required in the future, it is vital that one not violate the Look-Back Rule. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds and Medicaid Planners are aware of them. It is strongly recommended one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Personal Preference Program / Personal Care Assistant Services
Before You Apply
Prior to applying for the Personal Preference Program, applicants need to ensure they meet New Jersey’s Medicaid eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, previous bank statements, and proof of income. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Application Process
To enroll in the Personal Preference Program, persons must be eligible and enrolled in Medicaid (NJ FamilyCare Plan A). One can apply one online or via their local County Board of Social Services office. Additionally, one can download an application for the NJ FamilyCare Aged, Blind, Disabled Program.
Once enrolled in NJ FamilyCare Plan A, one should contact their Managed Care Organization (MCO) to request an assessment for Personal Care Assistant Services and initiate enrollment in PPP. See a list of current MCO’s / NJ FamilyCare Health Plans (halfway down the page).
Persons can learn more about the Personal Preference Program (PPP) here and / or call the PPP Helpline at 609-631-2481. More on Personal Care Assistant Services.
The State of New Jersey’s Department of Human Services’ (DHS) Division of Medical Assistance & Health Services (DMAHS) administers the Personal Preference Program.
Approval Process & Timing
The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.