Understanding Medicaid Eligibility for Assisted Living Admission

HNWMedicaid Eligibility and Asset Protection Planning

  • To understand Assisted Living Medicaid, you must understand New Jersey’s Medicaid laws.
  • You also need to understand the Medicaid history concerning assisted living admission as the history is important.

Medicaid applicationNew Medicaid and Assisted Living

Medicaid is a cooperative program between the states and the federal government.  New Jersey provides Medicaid to medically needy individuals who are clinically and financially eligible.  New Jersey’s Medicaid plan allows Assisted Living facilities to receive payment from Medicaid under a specific program, called Managed Long Term Services and Supports, or MLTSS.  The Assisted Living Medicaid program is unique – it is the only Medicaid program which allows an individual or their family to supplement the amount Medicaid pays the facility for a private room vs. mandatory shared occupancy.  All other Medicaid providers must accept a Medicaid payment as payment in full.  To become eligible for Medicaid, a person has to first complete an application for New Jersey Family Care with the county.

In 2015, the expansion of Home and Community Based Services (“HCBS”) eliminated many of the limitations for the Medicaid Assisted Living program.  For persons with excess income, a Qualified Income Trust allows someone who meets the clinical medical eligibility for the MLTSS program (this means someone needs a nursing home level of care) to stay at an Assisted Living residence, if they have enough income to pay for their room and board from the income that is paid to the QIT each month.

The Medicaid Application Process for ALF Medicaid

Each application has two components, one part is medical eligibility, the second is financial eligibility.  Assisted Living facilities can accept Medicaid if they choose.  Assisted Livings built after 2010 are required to devote a minimum of 10% of their beds to Medicaid eligible individuals, but they can choose to accept Medicaid from other individuals too.

Under New Jersey’s Medicaid Plan, Assisted Living facilities are allowed to accept an unlimited number of individuals who are eligible for MLTSS.  This is something called “Money Follows the Person”.

Prior to 2014, aging persons could only participate in Assisted Living Medicaid if they qualified for a program called Global Options.  Global Options, unlike MLTSS, didn’t allow people with higher income levels to participate.  This is really important.  When MLTSS was expanded, it was meant to help the facility to actually get paid in a timely manner.

To conclude, there is no longer any limitations on the number of Medicaid Assisted Living “slots” or “beds”, and a facility may accept additional residents who are Medicaid Eligible once it has met the 10% minimum requirement.

To discuss your NJ Medicaid eligibility matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Medicaid Eligibility Attorney

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