Self-Directed Personal Care Assistance via the New Jersey Medicaid Personal Preference Program

Last updated: June 02, 2021

 

Overview of Personal Preference Program / Personal Care Assistant Services

New Jersey’s Personal Preference Program (PPP) is a participant-directed program for elderly and disabled NJ FamilyCare (Medicaid) beneficiaries who 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 friends and relatives, including one’s spouse, to provide personal care assistance (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 a program requirement is that persons 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.

The Personal Preference Program / Personal Assistant Services is an entitlement. This means persons who meet the program and service requirements are able to participate in PPP without a delay. Put differently, there are not a limited number of participant enrollment slots, which means there is no waitlist for program participation.

Personal Care Assistance Services are available via New Jersey’s state Medicaid plan. 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.

 What is Participant-Directed Care?
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

With 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 assistance 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

Program participants can live their own home or the home of a loved one. They cannot live in an assisted living residence or an adult foster care home and participate in PPP. However, they can live in a congregate setting and participate in this program, given personal care assistance services are not provided.

 

Eligibility Requirements for Personal Preference Program / Personal Care Assistant Services

The Personal Preference Program is for New Jersey residents who require personal care assistant services and can self-direct their care. To be eligible, persons must be enrolled in NJ FamilyCare Plan A (Medicaid). While several groups of NJ residents can qualify for NJ FamilyCare Plan A, this webpage is relevant to those who qualify for Aged, Blind, Disabled (ABD) Programs, which includes long term care.

 The American Council on Aging now provides a NJ Medicaid eligibility test for seniors

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance. There is a minimum income allowance, set at $2,177.50 / month (effective July 2021 – June 2022), which is intended to bring a non-applicant spouse’s monthly income up to this amount. There is also a maximum income allowance, which is $3,259.50 / month (effective January 2021 – December 2021), and is dependent on the non-applicant spouse’s shelter and utility costs. This monthly maintenance needs allowance is intended to ensure the non-applicant spouse does not become impoverished.

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

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.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator.  

Home Ownership
The home is often the highest valued asset a New Jersey Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, 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 to the home and his / her home equity interest is no greater than $906,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor, blind, or disabled child living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

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. However, the need cannot be so extensive that the individual requires a nursing facility level of care (NFLOC). Furthermore, the need for personal care assistance must be documented by a doctor and one must require personal care services for a minimum of 6 months. Persons with Alzheimer’s disease or a related dementia may be eligible for PPP, but a diagnosis of dementia in and of itself does not mean one will automatically meet the functional need.

 For more information about long-term care Medicaid in New Jersey, click here.

 

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.

When persons have income over the limits, Miller Trusts, also called a qualified income trust can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts 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 the state of 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.

These strategies often violate Medicaid’s 60-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds and Medicaid planners are aware of them. Therefore, 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 free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, 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). An application for the NJ FamilyCare Aged, Blind, Disabled Program can be downloaded here. To apply for PPP and request a functional assessment for personal care assistant services, one should contact their local County Board of Social Services office. Contact information can be found here. Alternatively, one can contact their local Area Agency on Aging (AAA) / Aging and Disability Resource Connection (ADRC). County specific information can be found here.

Those already enrolled in NJ FamilyCare, should contact their Managed Care Organization (MCO) to request an assessment for personal care assistant services and initiate enrollment in PPP. A list of current MCO’s / NJ FamilyCare Health Plans and contact information can be found towards the bottom of this webpage.

More information about the Personal Preference Program (PPP) can be found here. Persons can also call the PPP Helpline at 609-631-2481. Click here for additional information about 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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further.

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