New Jersey Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

New Jersey offers long-term care resources to seniors through the New Jersey Department of Human Services (DHS), Division of Aging Services (DoA)and the Division of Disability Services (DDS). The Division of Aging Services administers federal and State-funded services and supports and makes it easier for seniors and caregivers to live in the community as long as possible with independence, dignity and choice. The agency receives federal funds under the Older Americans Act whereby it serves over 500,000 individuals and is the focal point for planning services for the aging, developing comprehensive information about New Jersey’s older adult population and its needs, and maintaining information about services available to older adults throughout the state.

The Division of Disability Services provides Managed Long Term Services and Supports (MLTSS) Enrollment Assistance. MLTSS refers to the delivery of long-term services and supports through New Jersey Medicaid NJ FamilyCare managed care program. MLTSS is designed to provide the long term supports and services individuals need to remain in the community for as long as possible.

Finally, through the DHS, New Jersey Division of Aging Services handles local aging agencies. Each Area Agency on Aging(AAA) is designated in New Jersey's 21 counties to serve as the primary entity responsible for developing comprehensive, coordinated systems of community-based services for older adults. AAAs also serve as Aging & Disability Resource Connection (ADRC) lead agencies in their county, ensuring seniors, adults with disabilities and their caregivers have easy access to information and long term services and supports.

The role of the AAAs includes: 1) Coordinating all programs on aging regardless of funding source, and serving as the central source for information and referral for services and programs; 2) Preparing an Area Plan on Aging which includes an analysis of the needs and existing services within the county and a comprehensive plan for the delivery of services to older people; 3) Administering the annual allocation of federal Older Americans Act and state funds from the New Jersey Division of Aging and Community Services for projects and services within the county; 4) Monitoring and evaluating projects funded under the Area Plan; 5) Serving as an advocate to increase the public's understanding of the nature of the aging process and the aging individual; and 6) Advising local governments and the Division of Aging and Community Services of unmet needs, and recommending legislation where appropriate.

Medicaid Waiver Program For Assisted Living and In-Home Care

New Jersey FamilyCare 1115 Comprehensive Demonstration Renewal Application (Section 1115 Demonstration Medicaid Waiver)

New Jersey operates its Medicaid waiver program under a Section 1115 demonstration waiver, which has completely reorganized the way long-term care services are delivered to seniors in New Jersey. By utilizing this demonstration waiver, New Jersey no longer operates separate waiver programs for target populations, but rather streamlines the Medicaid waiver program through one service provider. The specific service provided under the Comprehensive Waiver is called the Aged, Blind, and Disabled, Long-Term Services and Support Program (ABD, LTSS)

Managed Long Term Services and Supports(MLTSS) refers to the delivery of long-term services and supports through New Jersey Medicaid NJ FamilyCare managed care program. MLTSS uses NJ FamilyCare Managed Care Organizations (MCOs) to coordinate all services. MLTSS can be provided in the following settings: Private Home/Apartment; Subsidized Housing; Assisted Living Type Facilities; Nursing Facility; Special Care Nursing Facility. To qualify, an applicant must be both clinically and financially eligible. The local County Welfare Agency will do the financial evaluation using information provided in the Aged, Blind, Disabled Application while the Division of Aging Services is responsible for the clinical eligibility determination for LTSS. The two evaluations are completed concurrently and are coordinated between both agencies.

Services:

Services include: Personal Care; Respite; Care Management; Home and Vehicle Modifications; Home Delivered Meals; Personal Emergency Response Systems; Mental Health and Addiction Services; Assisted Living; Community Residential Services; and Nursing Home Care.

Eligibility:

  1. Health: An applicant must meet the state’s Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset limits to qualify for Medicaid eligibility for the ABD, LTSS program. For 2017, the individual income limit is $2,205 and the individual asset limit is $2,000. In determining financial eligibility, if the gross monthly income exceeds the income limit allowed, he or she can establish and fund Miller Trust, or a Qualified Income Trust, with the excess income that is above the limit.

Practical Considerations:

The new Medicaid waiver program in New Jersey provides a streamlined application process and should make it easier to access long-term care services such as assisted living and in home care. The Aged, Blind and Disabled Long-Term Care and Supports program essentially mirrors the traditional home-and-community based (HCBS) Medicaid waiver service and in New Jersey has the same special income limit and ability to use a Miller Trust.

To apply for the program you can either: 1) Go in-person by visiting your local County Welfare Agency (call 1-800-356-1561 to locate a County Welfare Agency); or 2) Complete and mail the application. The application and supplemental forms, including the Authorized Representative form, can be found online here.

Conclusion

New Jersey’s Medicaid waiver program is different than most states, however, the health and financial eligibility criteria are similar to most HCBS Medicaid Waiver programs. While not officially a HCBS Medicaid waiver, New Jersey’s Section 1115 Demonstration Waiver allows seniors access to long-term care in their community or in their own home.