Whether you’re planning for yourself or a loved one, it is important to know and understand how Medicaid works and how to be positioned for eligibility.
Managed Long Term Services and Supports (MLTSS) refers to the delivery of long-term services and supports through New Jersey Medicaid’s NJ FamilyCare managed care program. MLTSS uses NJ FamilyCare managed care organizations (also known as HMOs or health plans) to coordinate services. MLTSS provides comprehensive services and supports, whether at home, in an assisted living facility, in community residential services or in a nursing home.
Under current law, the cost of a stay in a skilled nursing home is not likely to be covered by Medicare or a Medicare HMO because the care most people receive in a nursing home is deemed “custodial” and not “skilled” care. Medicare will only pay skilled nursing care or rehabilitation needed as the result of a hospitalization, and then only for a limited amount of time. Medicare will not pay for long-term care.
The Medicaid program is administered and regulated by both the federal and state governments. Thus, the rules differ from state to state. Applicants must be 65 years of age or older, blind or permanently disabled.
Some important facts about Medicaid in New Jersey:
- Applicants must be deemed medically eligible
- Applicants must meet program asset and income eligibility guidelines
- If the applicant has a spouse that will remain at home, Medicaid allows for the spouse to keep a certain amount of assets and their income
- Medicaid will review five years of financial information for the applicant (and spouse)
The Medicaid spend down strategy and application process can be complex, but a knowledgeable elder law attorney can help families successfully navigate Medicaid’s eligibility requirements.
The experienced team at Timothy Rice Estate & Elder Law Firm guides clients through the Medicaid asset protection and planning process. We provide trusted counsel on sometimes difficult and complex decisions so that you or your loved ones can make the right choices for your future.