Understanding Eligibility for an Assisted Living Residence Under New Jersey Medicaid – Part 1 of 2

HNWMedicaid Eligibility and Asset Protection Planning

  • Applying for MedicaidTo understand Assisted Living Medicaid, you have to understand New Jersey Medicaid first. The history is important.
  • New Jersey provides Medicaid long term care to medically needy individuals who are clinically and financially eligible under a plan document called a 1115 Demonstration. This is New Jersey’s Medicaid “plan”.  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.

Under prior law, our state’s old Medicaid rules were part of a plan called a §1915(c) waiver.  Under the §1915(c) waiver, there were a specific number of Medicaid “slots” or “beds” available in assisted living through Global Options (commonly identified as “GO”).  The expansion of Home and Community Based Services (“HCBS”) under the 1115 Demonstration Plan eliminated the cap on the Medicaid assisted living program, and phased out GO as of June 2014.  In its place, we now have a Qualified Income Trust (“QIT”) to allow someone who meets the clinical eligibility for the MLTSS program (this means someone needs a nursing home level of care) to stay at an assisted living program, if they have enough income to pay for their room and board.  If they do not have enough income, they are required to apply for supplemental security income (“SSI”).  Once the individual is enrolled in MLTSS, the individual’s room and board rate becomes the contracted rate of $73 per day, but up until enrollment, the individual’s room and board rate is the contract rate between the individual and the provider.

In my next post, I’ll explain more about Assisted Living Medicaid eligibility.

To discuss your NJ Medicaid 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 or telephone 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 Attorney

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