Here you'll find essential information about eligibility and financial criteria specific to New Jersey. We’ve streamlined the details to make it easy to understand and navigate. Follow the provided links for more in-depth information on topics that apply to all states.
The programs outlined here are comprehensive of what the state of New Jersey offers residents. However, these are not your only options; many other financial options are available. When searching for assistance options, it’s important to explore all avenues to find a solution that truly fits your needs. You can review the additional resources on this website to learn more.
Institutional or Nursing Home Medicaid provides financial assistance for individuals who require a high level of care and reside in a nursing home or other institutional settings. This program covers the basics, including room and board and access to medical care when needed. To be eligible, applicants must have an income and assets that fall below state-specific limits.
Key Benefits:
Medicaid Waiver programs are state-run initiatives that provide home and community-based services (HCBS) to seniors who would otherwise require care in a nursing home or other institutional settings. These programs offer a sense of freedom and confidence to seniors, allowing them to receive care in the comfort of their own homes or local communities.
Some Services That May Be Covered:
Key Benefits:
Click here for additional information on Waiver Programs.
The Aged, Blind, and Disabled (ABD) Medicaid program provides essential healthcare and long-term care services to financially limited residents who are 65 or older, blind, or disabled and living in the community. Unlike general Medicaid, ABD Medicaid is specifically designed for these vulnerable groups.
Some Services That May Be Covered:
Key Benefits:
Age and Residency:
To qualify, you must be a Pennsylvania resident aged 65 or older and meet the state’s criteria for a Nursing Facility Level of Care, even if they are applying for Assisted Living or Home Care services.
Asset Limits:
Countable vs. Non-Countable Assets:
Retirement accounts: 401(k) and IRA Accounts:
The treatment of retirement accounts in long-term care Medicaid eligibility varies by state. In some states, retirement accounts like IRAs and 401(k)s are counted as assets for both the applicant and their spouse, while other states may only count them for the applicant. In many cases, if the accounts are in payout status (i.e., the individual is taking required minimum distributions), only the income from the distributions is counted, and the principal may be exempt. However, a few states exempt retirement accounts for both the applicant and the spouse, regardless of whether they are in payout status. Since rules differ significantly across states, it is essential to consult state-specific Medicaid guidelines or a professional Medicaid planner.
Home Equity Limit:
Home Exemption Note: If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest and regardless of where the applicant lives.
Community Spouse Resource Allowance (CSRA). The CSRA is designed to prevent the impoverishment of the community spouse by allowing them to keep a portion of the couple’s resources. In New Jersey the CSRA works by evaluating the couple’s combined countable assets and then splitting them in half. The community spouse is then allowed to keep up to a maximum of $154,140.00 and a minimum of $30,828.00 if half falls below that.
Community Spouse Resource Allowance (CSRA): The non-applicant spouse (community spouse) can retain up to $154,140.00 in assets.
Minimum Monthly Maintenance Needs Allowance (MMMNA): This is the minimum amount of income the community spouse is allowed to retain, which in 2024 ranges from $2,465.00 to $3,853.50 per month, depending on housing costs. This ensures the community spouse has sufficient income to meet their living expenses.
Nursing Home Residents: New Jersey Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They keep a “personal needs allowance” (PNA).
PNA In New Jersey: $50.00
New Jersey has a 5-year look-back period. Any asset transfers for less than fair market value during this period may result in a penalty period of ineligibility.
The transfer penalty is a rule in Medicaid planning that applies when someone gives away or transfers assets for less than fair market value within a certain period before applying for long-term care Medicaid. This period is called the look-back period, which is typically 60 months (5 years) in most states. If any such transfers are found during the look-back period, Medicaid may impose a penalty, which delays the applicant’s eligibility for Medicaid benefits.
Example:
Let’s say an individual applies for Medicaid and is found to have transferred $50,000 to their child two years before applying. In their state, the average monthly cost of nursing home care is $10,000. To calculate the penalty, the amount transferred ($50,000) is divided by the average monthly cost of care ($10,000), resulting in a 5-month penalty period. During this 5-month period, Medicaid will not cover the individual’s nursing home costs, and they will need to pay out of pocket.
The penalty starts only when the person is otherwise eligible for Medicaid (in terms of income and assets) and has applied for Medicaid, so it’s crucial to time any transfers carefully when planning for long-term care.
Per Day: $440.10 Per Month: $13,386.38
NOTE: The U.S. Federal Gift Tax Rule does affect Medicaid eligibility. In 2024, individuals can gift up to $18,000 per recipient without filing a Gift Tax Return. However, gifting under this rule still violates Medicaid’s Look-Back Period, which may result in penalties when applying for Medicaid.
Definition: Estate recovery refers to the process by which Medicaid seeks reimbursement for long-term care costs from the estates of deceased beneficiaries. In New Jersey, the state has not expanded the definition of “estate” beyond those assets that go through probate, meaning that Medicaid can only recover from assets that are part of the probate estate.
Hardship Provision: In New Jersey, an exception is built into the estate recovery plan. This provision kicks in when seeking to recoup costs from an estate would cause serious financial strain on the family left behind.
Implementation: Yes, New Jersey has implemented a Long-Term Care Partnership program. This program allows individuals who purchase qualifying long-term care insurance policies to protect a portion of their assets equal to the amount of benefits paid out by the policy if they later need to apply for Medicaid.
Medicaid provides coverage for nursing home care for individuals who medically require a Nursing Home Level of Care and meet the necessary financial criteria. In addition to nursing home care, Medicaid also offers programs for seniors who may need nursing home-level care but prefer to stay at home or in a community-based setting. These programs provide essential care and support services that allow individuals to remain independent while receiving the necessary assistance to meet their health and daily living needs. This ensures a comprehensive approach to long-term care that includes options beyond institutional settings.
The Managed Long-Term Services & Supports (MLTSS) program is designed to provide comprehensive long-term care services and healthcare coverage to New
Jersey Medicaid beneficiaries who require a Nursing Facility Level of Care, yet prefer to reside in settings such as their own home or with family. MLTSS covers essential services like those listed below. Managed through Medicaid health plans managed by care organizations, participants have the flexibility to self-direct certain services, such as personal care assistance and housekeeping.
Benefits can include:
Participants receive these benefits, as well as their medical care, through a single Medicaid health plan. The plan is handled by a managed care organization, which has a network of care providers. However, participants can also go outside the network for some benefits, like personal care assistance and housekeeping, and self-direct their care by hiring caregivers of their choice, including spouses, adult children, siblings, and other adult family members.
No limit on enrollment : All eligible applicants will receive benefits without delay.
The Personal Preference Program (PPP) supports New Jersey ABD Medicaid recipients who need assistance with daily activities but do not require a Nursing Facility Level of Care. Beneficiaries can receive services like those listed below. PPP offers a monthly budget for approved medical goods and services, empowering recipients to manage their care by choosing their caregivers, including family members.
Benefits include:
A financial management company helps with some aspects of the PPP program, such as making payments to caregivers and withholding taxes.
Entitlement program : All eligible applicants are guaranteed by law to receive benefits without any wait.
PACE is a collaborative initiative between Medicare and Medicaid aimed at providing comprehensive community-based care and services to eligible seniors. Eligible seniors can initiate the application process through designated PACE centers in New Jersey.
Services include:
This federal program supports Medicaid-eligible individuals in transitioning from institutionalized settings back to their homes or communities in New Jersey.
Applying for New Jersey Medicaid involves several steps to ensure you meet the eligibility requirements and submit the necessary documentation. Here’s how you can apply:
1. Gather Necessary Documents: Before you start the application process, collect important documents such as proof of identity, residency, income, and assets. This might include your Social Security card, birth certificate, proof of New Jersey residency, bank statements, and information about your income and expenses.
2. Online Application: You can apply for Medicaid online through the New Jersey Department of Human Services (DHS) website using the NJ FamilyCare online portal. Visit the NJ FamilyCare website to begin your application.
3. Paper Application: If you prefer, you can complete a paper application. Download the application form from the New Jersey DHS website or request it from your local County Welfare Agency (CWA). Once completed, mail it to your local CWA office.
4. In-Person Application: You can also apply in person at your local County Welfare Agency (CWA). Use the CWA Directory on the New Jersey DHS website to find the nearest office.
5. Phone Application: For assistance over the phone, you can contact the New Jersey DHS Customer Service at 1-800-356-1561. They can provide information on how to apply and help you with the application process.
6. Follow-Up: After submitting your application, you may need to provide additional documentation or information as requested by the DHS. Respond promptly to any requests to avoid delays in processing your application.
7. Approval and Enrollment: Once your application is processed and approved, you will receive a notice of eligibility. You can then select a Medicaid Managed Care Organization (MCO) if applicable. For more information about selecting an MCO, visit the NJ FamilyCare website.
New Jersey residents can find nursing homes across the state using the New Jersey Department of Health’s Nursing Care Facility Locator. This tool includes an interactive map to help you easily locate facilities. Additionally, you can use the Nursing Home Compare tool administered by the Centers for Medicare & Medicaid Services (CMS), which provides detailed information on nursing homes nationwide, allowing for comparisons and informed decisions.
New Jersey is a leader in providing assistance to elderly individuals who are not eligible for Medicaid. The state offers five programs that can help seniors and their families save money on care costs.
Provides non-medical, home support services to help seniors live independently.
Benefits include:
Allows self-direction of care services, enabling seniors to hire the person of their choice, including family members
For more detailed information on these topics, please visit the following pages:
For personalized assistance or more detailed information, you can contact your local Medicaid Office