How to Get into a Nursing Home When Medicaid is Needed ASAP
Getting into a nursing home as a Medicaid recipient is not always easy. With the median cost of a nursing home room being more …
NJ Announces 2024-2025 Increases in Allowances and Exemptions to Community Spouses, Dependents and Home Exemption Figures
Every year NJ announces changes to its regulations which govern the amount of money a community spouse (a community spouse is the spouse who …
You Really Really Need to Consider Long Term Care Insurance
I see it every day at the office. A diagnosis of a degenerative condition is received by a family member. Panic sets in. How …
How is a Resource Valued to Determine Medicaid Eligibility?
In this State, in order to qualify for Medicaid benefits, an applicant’s resources cannot exceed $2000. N.J.A.C. 10:71-4.5(c). Resources are defined as: any real …
Protect Your 401k or IRA from NJ Medicaid
Under the federal regulations for Social Security Income (SSI) eligibility, the 401k’s of a spouse living with the applicant are specifically excluded resources. See …
Is a Line of Credit Income Under NJ Medicaid Eligibility Standards?
A line of credit is not income for the purpose of Medicaid eligibility. Borrowed funds are specifically excluded from income for the purpose of …
Medicaid Balanced Billing: A Medicaid Approved Provider Cannot Demand More Money Than Medicaid Pays
Balance billing by Medicaid providers is clearly prohibited by both state and federal law. Under 42 U.S.C. § 1396u-2: Each Medicaid managed care organization …
Use of Self-Attestation
States may accept self-attestation of non-financial eligibility criteria for Medicaid, except as required by law or regulation (citizenship and immigration status, Asset Verification System). …
Processing New Applications
For Medicaid, CHIP, and BHP, states must accept applications from the applicant, an adult in the applicant’s household, an authorized representative, or if the …
Changes in Circumstances
States must have procedures in place designed to ensure that beneficiaries in Medicaid, CHIP, and a BHP can timely and accurately report changes in …
Reconsideration Period
For MAGI Medicaid and CHIP beneficiaries whose eligibility has been terminated at renewal, the agency must reconsider the individual’s eligibility without requiring the individual …
Considering Eligibility on Other Bases and Eligibility for Other Insurance Affordability Programs
If a Medicaid beneficiary is no longer eligible for the category in which the beneficiary is enrolled, the Medicaid agency must consider whether the …
Renewal Form Requirements
If an ex parte renewal cannot be completed, the agency must provide beneficiaries with a renewal form and request information from the beneficiary. The …
Understanding the Ex-Parte Renewal Process for Continued Medicaid Eligibility When the COVID-19 Public Health Emergency Ends
In my previous blog I discussed how NJ will conduct renewals for continuing Medicaid eligibility. In this blog I will go over understanding the …
How Will NJ Conduct Renewals for Continuing Medicaid Eligibility
In my previous blog I discussed what to do when NJ seeks to terminate your Medicaid long-term care benefits when the COVID-19 emergency ends. …
What to Do When NJ Seeks to Terminate Your Medicaid Long-Term Care Benefits When the COVID Emergency Ends
Under the FFCRA, New Jersey must maintain continuous enrollment of Medicaid beneficiaries through the last day of the month in which the PHE ends, …
Court Ordered Alimony: Can Medicaid Deny Court-Ordered Alimony Payments to a Community Spouse?
NJ Medicaid and Court Ordered Alimony Video I was recently asked if I knew of any statutory or other persuasive authority supporting the …
Is Your NJ Business Exempt From Mandatory Spenddown to Qualify for Medicaid?
When the State considers an applicant’s eligibility for Medicaid, it meticulously examines the applicant’s finances to ensure that all resources are valued below the …
The After Thought of Transferring Assets – A Real Life Example of Good Intentions Going Wrong
When I talk to some people about long-term care and Medicaid, I sometimes hear strong opinions that “it is wrong to transfer assets in …
You Cannot Avoid a Medicaid Estate Recovery Lien by Creation of an Elective Share Trust
The estate argued that the assets held in a trust created by a spouse are not subject to recovery by NJ because these assets …
NJ Must Abide by its Federally Approved State Medicaid Plan and Make Available Assisted Living and Home-Based Community Assistance Services to Eligible Medicaid Applicants
Under federal law, NJ is allowed to offer expanded Medicaid programs to individuals whose income exceeds the Medicaid income cap. Since NJ proposed to …
Understanding Eligibility for an Assisted Living Residence Under NJ Medicaid – Part of 2
Each applicant for Assisted Living Medicaid has two components, one part is clinical eligibility, the second part is financial eligibility. One way to become …
Understanding Eligibility for an Assisted Living Residence Under New Jersey Medicaid – Part 1 of 2
To understand Assisted Living Medicaid, you have to understand New Jersey Medicaid first. The history is important. New Jersey provides Medicaid long term care …
Medicare Scams
There is a new Medicare telephone scam. Scammers are calling, and identifying themselves as from Medicare. Then, they are asking for Medicare numbers and …
Income Derived from Personal Businesses Must Be Counted for Eligibility for Benefits
When applying for welfare through a county’s Board of Social Services, whether it’s Medicaid or SNAP benefits, you are required to provide to the …
Federal Government Reinstates Restrictions on Nursing Homes to Discharge Residents and Relocate Them Within Facility Under Covid
When the COVID-19 emergency began, the Centers for Medicare and Medicaid, the federal agency which controls the administration of long term care facilities, issued …
New Jersey Family Care: Federal Government Agency and New Jersey Agency Together Extend Time for Families to File Appeals
For many New Jersey families, COVID-19 has made it impossible for them to keep their health insurance. That means more people and families than …
If You’re Going to Loan Money to a Parent, Do a Promissory Note and Keep Good Records
Older persons often have their liquid assets tied up in real estate, mutual funds and annuities. They cannot gain access to these funds quickly …
Understanding Medicaid Eligibility for Assisted Living Admission
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 …
Is an Income Producing Property Exempt from Spenddown Under NJ Medicaid?
I was recently asked to evaluate whether income producing real estate is exempt from spend-down under NJ Medicaid. Federal law sets forth a mechanism …