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

Last updated: March 12, 2024

 

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 friends and relatives, including one’s 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 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.

Program participants can live their own homes 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, given personal care assistance services are not provided.

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 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.

 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 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 who require personal care assistant services and can self-direct their own 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) Medicaid through NJ’s State Plan Medicaid program.

 The American Council on Aging now provides a NJ Medicaid Eligibility Test for seniors

 

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.

  New Jersey seniors can also qualify for the Personal Preference Program / Personal Care Assistant Services via NJ’s Medicaid Managed Long-Term Services and Supports (MLTSS) Program. Qualifying via MLTSS allows for a higher income limit. Furthermore, a non-applicant spouse is entitled to a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance, and a Community Spouse Resource Allowance.

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 in 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.

 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 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.
– A spouse lives 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 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. 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.

 Learn more about long-term care Medicaid in New Jersey

 

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, 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 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 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, previous bank statements, 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. Alternatively, one can contact their local Area Agency on Aging (AAA) / Aging and Disability Resource Connection (ADRC).

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.

Persons can learn more about the Personal Preference Program (PPP) 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. 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.

Determine Your Medicaid Eligibility

Get Help Qualifying for Medicaid