Understanding Eligibility for an Assisted Living Residence Under NJ Medicaid – Part of 2

HNWMedicaid Eligibility and Asset Protection Planning

  • Applying for MedicaidEach applicant for Assisted Living Medicaid has two components, one part is clinical eligibility, the second part is financial eligibility.
  • One way to become “Medicaid eligible” financially is to place your income inside of a QIT, also known as a Qualified Income Trust.

Under New Jersey’s Medicaid Plan, assisted living facilities are allowed to accept an unlimited number of individuals who are eligible for MLTSS long term care.

Our state’s 1115 Demonstration Plan changed the way Medicaid funds placements in assisted living residences.  The expansion of Medicaid for Assisted Living Residences really took off on December 1, 2014 when a policy statement was issued by the Department of Human Services, Division of Medical Assistance and Health Services – our government agency in charge of “Medicaid” was approved by CMS.  In a nut shell, that policy statement says people living in assisted livings who are clinically and financially eligible to participate in a specific Medicaid program – MLTSS – can have their bills paid for almost immediately under another policy, called fee for service.

Prior to 2014, these people 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.

The state allows assisted living facilities to bill per diem rates under the fee for service system, from the date when both clinically and financial eligibility are established, until the person has a managed care organization assigned and that organization accepts responsibility for paying for the person’s MLTSS services.  This is really important.  It is possible someone might have too much income to qualify for Medicaid without a QIT.

To conclude, there is no longer any cap 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. If it does so, it can receive additional payments from the resident or their family. QITs were designed to eliminate waiting periods for eligibility. They are a cost savings mechanism for the state: it costs the state less to house a person clinically eligible for MLTSS using the HCBS waiver in an Assisted Living than it does to house them in a Nursing Home, and it supports the state’s goal of de-institutionalization.

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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