How Medicaid Pays for New Jerseyans Needing Assisted Living or Home Health Care

New Jersey has transitioned Medicaid waiver services to Managed Long-Term Services and Supports.

New Jersey has recently changed its Medicaid-based system for providing assisted living and home health care services to Medicaid recipients. New Jersey hopes this change will allow more people to delay going to Medicaid-paid nursing homes and instead to rely on assisted living facilities, which are generally less expensive and less medically intensive than nursing homes, and/or home health care, which can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning.

In the past, New Jersey served elderly and disabled individuals needing home- and community-based long-term care services through several different Medicaid Waiver programs. Because long-term care is so expensive and accounts for a large part of New Jersey’s Medicaid expenditures, the state has transitioned long-term care recipients into a new Managed Long-Term Services and Supports (MLTSS) program.

Managed Long-Term Care in New Jersey

With Managed Long-Term Services and Supports, New Jersey no longer pays for each long-term care expense for every Medicaid recipient. Instead, it pays a fixed amount to private companies to manage the long-term care needs of its Medicaid recipients. In MLTSS, Medicaid recipients enroll with one of New Jersey's five managed care organizations (MCOs) or a Program of All-Inclusive Care for the Elderly (PACE).

In July 2014, New Jersey transitioned all of its Medicaid recipients who were receiving Medicaid Waiver services to MLTSS. Individuals who are entering a nursing home for the first time after July 1, 2014, must enroll either in MLTSS or a PACE program. Individuals who had already been living in a nursing home will enroll in MLTSS after July 1, 2016.

If you are 65 or older, disabled, or blind, meet the financial criteria for Medicaid, and need a nursing home level of care, then you qualify for MLTSS. New Jersey defines the nursing home level of care as needing help with activities of daily living such as bathing, grooming, using the toilet, and getting around. (See Nolo's article on when New Jersey Medicaid pays for nursing homes to learn about financial and medical eligibility for long-term care.)

Managed Long-Term Services and Supports emphasizes individual care coordination and has increased funding for home and community-based long-term care services like assisted living facilities and home health services. MLTSS offers a full range of long-term care options, from nursing homes to in-home services and supports, depending on the needs of the individual Medicaid recipient. In fact, every MCO must offer personal care services, respite care, care coordination, 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.

Not all MCOs are available statewide. You can get more information about choosing an MCO here, and you can get help choosing an MCO by contacting your local Aging and Disability Resource Center.

New Jersey PACE

New Jersey also offers a Program for All-Inclusive Care for the Elderly (PACE). PACE is only available in certain locations in the state. PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. PACE participants must be at least 55 years old and meet the nursing home level of care. If you are interested in a PACE program, apply directly to the one you are interested in, and they will help determine your eligibility. Medicaid will pay for PACE programs for individuals who qualify.

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