Summary
Medicaid’s rules, benefits and name can all vary by state. In New Jersey, Medicaid is also called NJ FamilyCare. This article focuses on New Jersey Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, Managed Long Term Services & Supports or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.
New Jersey Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited New Jersey residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
New Jersey Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
New Jersey Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
A Nursing Home Alternative – New Jersey Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through New Jersey’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In New Jersey, MFP is also known as I Choose Home.
New Jersey’s Managed Long Term Services & Supports (MLTSS) program provides long-term care services and supports, as well as healthcare coverage, to New Jersey Medicaid beneficiaries who require a Nursing Facility Level of Care but live in their home, the home of a loved one, an adult family care home, a comprehensive personal care home or an assisted living residence. While MLTSS will pay for benefits in those settings, it will not cover room and board costs.
MLTSS benefits can include adult day care, housekeeping, home modifications, in-home nursing care, meal delivery and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). MLTSS program 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, MLTSS program 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.
There is no limit on enrollment in the MLTSS program. This means that all eligible applicants will receive benefits without delay.
New Jersey’s Aged Blind and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to financially limited New Jersey residents who are aged (65 or over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.
New Jersey ABD Medicaid beneficiaries who show a functional need for long-term care benefits can receive some of those benefits through the Personal Preference Program (PPP) or the Living Independence for the Elderly (LIFE) program.
1. Personal Preference Program (PPP)
The Personal Preference Program (PPP) covers long-term care services for New Jersey ABD Medicaid recipients who don’t need a Nursing Facility Level of Care, but who do need help with completing some of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). PPP beneficiaries can live in their own home or the home of a loved one, but not in an assisted living residence or an adult foster care home. They can live in other congregate living situations as long as no personal care help is already being provided. While PPP may provide long-term care benefits in those settings, it will not pay for room and board costs, like mortgage payments, rent, facility fees, utility bills and food expenses.
PPP benefits include adult day care, home modifications, assistive technology, errand services and personal care assistance with the Activities of Daily Living and Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, medication management, transportation). PPP beneficiaries receive a monthly budget for allowable medical goods and services and they can self-direct their care by spending it however they want on those goods and services. They can even hire caregivers of their choice, including spouses, adult children and other family members. A financial management company helps with some aspects, such as making payments to caregivers and withholding taxes. Family members who are eligible caregivers include spouses, adult children, adult grandchildren, siblings, nieces and nephews.
Like ABD Medicaid itself, New Jersey’s PPP is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits without any wait.
2. Living Independence for the Elderly (LIFE)
New Jersey residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Living Independence for the Elderly (LIFE) program. LIFE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. New Jersey’s LIFE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. LIFE also administers vision and dental care, and LIFE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. New Jersey’s LIFE programs are located in Atlantic City (AtlantiCare LIFE Connection), Bordentown (Capital Health LIFE), Jersey City (Lutheran Senior Life at Jersey City), Oceanport (Beacon of LIFE), Pennsauken (Trinity Health LIFE New Jersey) and Vineland (Inspira Health LIFE). To learn more about LIFE, which is also called PACE, click here. And this New Jersey Department of Human Services webpage has information on the state’s PACE/LIFE programs.
To be eligible for New Jersey Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Managed Long Term Services & Supports (MLTSS) or Aged, Blind, and Disabled (ABD) Medicaid.
Just For You: The easiest way to find the most current New Jersey Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder.
Financial Requirements
New Jersey residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for New Jersey Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, New Jersey Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying, the 2024 asset limit for New Jersey Nursing Home Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for New Jersey Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, New Jersey has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in New Jersey is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if an applicant meets this level of care requirement, New Jersey Medicaid will conduct an in-person assessment that takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive functioning.
Financial Requirements
New Jersey residents have to meet an asset limit and an income limit in order to be financially eligible for Managed Long Term Services & Supports (MLTSS). For a single applicant in 2024, the MLTSS asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for MLTSS for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, MLTSS beneficiaries who live in an assisted living residence, comprehensive personal care home or an adult family care home are only allowed to keep $135.80/month of their income as a “personal needs allowance” and must give the state the rest to help offset the cost of residing in those settings. MLTSS beneficiaries who live in their own home or the home of a loved one can keep all of their income.
For married applicants with both spouses applying, the 2024 asset limit for New Jersey’s MLTSS is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.
Plan Ahead: There are alternative pathways to eligibility for New Jersey MLTSS applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, New Jersey has a Look-Back Period of five years. This means the state will look back into the previous five years of the MLTSS applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for New Jersey’s Managed Long Term Services & Supports program is needing a Nursing Facility Level of Care. To determine if an applicant meets this level of care requirement, New Jersey Medicaid will conduct an in-person assessment that takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive functioning.
Financial Requirements
New Jersey residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for New Jersey ABD Medicaid for a single applicant is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants in 2024, the asset limit for New Jersey ABD Medicaid is a combined $6,000, and the income limit is a combined $1,704/month. This applies to married couples with both spouses applying or with just one spouse applying.
Plan Ahead: There are alternative pathways to eligibility for New Jersey ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While New Jersey has a Look-Back Period of five years for Nursing Home Medicaid and MLTSS applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or MLTSS, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The only functional requirement to receive basic healthcare coverage through New Jersey ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long-term care benefits the state will cover.
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
New Jersey Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States (and the District of Columbia) are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in New Jersey and how you can protect your home from it, click here.
The first step in applying for a New Jersey Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Managed Long Term Services & Supports (MLTSS) or Aged, Blind, and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for New Jersey Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the New Jersey Medicaid applicant. These documents will be needed for the official New Jersey Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, New Jersey residents can apply for Medicaid online at this NJ FamilyCare webpage. They can also call and speak to a Health Benefits Coordinator at 1-800-701-0710.
For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) MLTSS 3) ABD Medicaid.
Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.
After getting approved for Nursing Home Medicaid through New Jersey Medicaid, your or your loved one needs to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right nursing home can be difficult, especially if you’re looking in a specific part of the state.
New Jersey has roughly 350 nursing homes, and most of them do accept Medicaid. The facilities are clustered around the major population centers, with most of them in the northeast corner of the state. There are about 15 nursing homes that accept Medicaid within the immediate vicinity of Newark, and then another 35 in the surrounding areas including Jersey City, Paterson and Elizabeth. There are about 15 facilities within 25 miles of Trenton, and another dozen or so along the southern Jersey Shore in the Atlantic City area.
Residents in many New Jersey communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, seniors with New Jersey Medicaid would not be covered for nursing homes in New York City or Philadelphia, even if facilities in those cities are well-suited or convenient for the New Jersey resident and their family.
TOOLS: To find and compare nursing homes, New Jersey residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this New Jersey Department of Health facilities finder.
When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can also be a great source of information. And you can contact your local Area Agency on Aging to find out more information about nursing homes in the state.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it handle dental and vision care? Does it provide transportation? What are the meals like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
CMS data shows the nursing homes in New Jersey fare much better than the average American nursing home when it comes to health conditions and fire safety. New Jersey nursing homes averaged 13.4 health deficiencies during a three-year period from 2019-2022, which is significantly lower than the national average of 25.7. The difference was even more striking when it came to fire safety deficiencies during that same time frame: New Jersey nursing homes averaged 6.4 and the national average was 13.5.
If you need Medicaid long term care but do not meet the financial eligibility criteria, consider working with a Medicaid Planning professional. These fee-based experts help families structure their finances to become eligible, while streamlining the application process and preserving assets for spouses and family members.
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