When Medicaid in New Jersey Will Pay for a Nursing Home

In New Jersey, long-term care in a nursing home is prohibitively expensive for most residents. In 2024, the average daily cost of a private room in a nursing home in New Jersey was $418 (about $12,700 per month).

Health insurance and Medicare typically don't cover long-term care. And few people purchase long-term care (LTC) insurance. That leaves Medicaid.

Medicaid is a very common source of funding for long-term care in New Jersey, particularly when people have already used up all of their own assets to pay for care. In fact, most nursing home residents use Medicaid to pay for their nursing home care.

There are many ways to become eligible for Medicaid—with specific eligibility rules for long-term care services like:

• nursing homes
• assisted living facilities, and
• home health care services.

Medicaid's Income Limit for Long-Term Care in New Jersey

New Jerseyans who are 65 or older (or disabled or blind) can qualify for Medicaid if they meet certain income and asset limits. The limits differ somewhat, depending on the type of Medicaid you need.

Qualifying for New Jersey Medicaid When You Receive SSI

If you receive Supplemental Security Income (SSI), you already qualify to receive Medicaid in New Jersey. But if you're elderly, blind, or disabled and not receiving SSI, then your income can't be more than 100% of the federal poverty level to get regular Medicaid services. In 2025, that means your monthly income must be less than $1,304 per month (for an individual) or $1,763 (for a couple, if both of you are applying for Medicaid).

Qualifying for LTC Medicaid in New Jersey

There's a higher income limit for seniors (and disabled or blind individuals) who need assisted living or home health services. If you're 65 or older, blind, or disabled, you can qualify for Medicaid long-term care services as long as your monthly income is no more than $2,901 per month for 2025. The limit for a couple is $5,802 per month (if both spouses are applying).

Qualifying for Medicaid Under New Jersey's Medically Needy Program

If your income is above the limit, you might still qualify for long-term care Medicaid in New Jersey—if you have a lot of medical expenses. With New Jersey's Medically Needy Program, you can use your monthly medical bills to "spend down" your income and qualify for Medicaid.

The Medically Needy spend-down income limit is $367 per month for an individual in 2025. If you have a household of two people, the income limit is $434 per month. You must show that paying your monthly medical expenses would leave you with no more than those amounts—but you don't actually have to pay the bills, just receive them.

Because nursing homes are so expensive, it can be relatively easy for nursing home residents to qualify for the Medically Needy Program. Your nursing home bills count as monthly medical expenses and help you spend down your income.

The Medically Needy Program determines eligibility over a period of six months.

Resource Limit for Long-Term Care in New Jersey

You must have few resources (assets like money and property) to qualify financially for Medicaid. In New Jersey, applicants for long-term care can have assets up to $2,000, or $3,000 for a married couple (with both spouses applying).

For applicants to regular Medicaid (aged, blind, and disabled), the resource limits are higher, so that an individual can have up to $4,000 in resources and still qualify. A couple with both spouses applying can have up to $6,000 in assets. People who qualify for the Medically Needy Program are also allowed up to $4,000 in resources, or $6,000 for a couple with both applying.

But not all property counts toward the LTC Medicaid resource limit. In New Jersey, your home (up to a value of $1,097,000 in 2025) is an exempt resource as long as it's your principal residence.

But when you live away from your home for six months (for example, in a nursing home), the state presumes it isn't your principal residence anymore—unless your spouse still lives there. Also, one car is exempt regardless of its value, as long as you or a family member uses it for transportation.

Keep in mind that if you're entering a nursing home and your spouse isn't, you'll be allowed to keep extra resources and income if needed to support your spouse, according to New Jersey's "community spouse allowance" rules. (N.J. Admin. Code. § 10:71-4.8.)

When a Nursing Home Is Medically Necessary

In addition to the income and asset limitations, New Jersey's Medicaid program covers nursing home care only when it's medically necessary. You must show that you need a "nursing home level of care," meaning that you have a physical or mental condition that requires nursing supervision and assistance with three or more activities of daily living (ADLs) like:

• bathing
• dressing
• eating, and
• other self-care.

In other words, you must show that you can't care for yourself without long-term services and support (LTSS).

Before Medicaid will pay for LTSS, like nursing home care, you must have a pre-admission clinical eligibility screening. New Jersey's Division of Aging Services Office of Community Choice Options will conduct the clinical screening to determine if you need nursing home-level care.

These screenings are usually done by nurses or social workers who visit you wherever you're living when you apply for LTC Medicaid. The screener asks you questions to determine whether you need help with your ADLs.

Medicaid uses the information in your screening to decide whether you need a nursing home and, if you do, what kind of nursing home or long-term services and support are appropriate for you. Medicaid also assesses whether you could stay in your home or in a community-based setting (like an assisted living center) if you were to receive supportive services.

Medicaid Managed Long-Term Care in New Jersey

New Jersey provides assisted living and home health care services to Medicaid recipients via Managed Long-Term Services and Supports (MLTSS) through the state Medicaid's NJ FamilyCare managed care program. This system is designed to allow more people to remain in their homes or assisted living facilities—both generally less costly and medically intensive than nursing homes—before needing Medicaid-paid nursing home care.

The MLTSS program streamlines access to long-term care services, replacing the multiple Medicaid home and community-based service (HCBS) waiver programs the state previously used. If you're a Medicaid recipient in New Jersey, MLTSS gives you access to a variety of long-term care options, including:

• assisted living
• nursing home care, and
• in-home support services, such as:
• skilled nursing or therapy
• home health aide assistance (like help with bathing or managing medications), and
• personal care aide support (like meal preparation and cleaning).

New Jersey's MLTSS program reduces Medicaid spending on long-term care while giving you more flexibility and choices for your care. Eligibility for MLTSS uses the same rules discussed above for long-term care Medicaid in New Jersey.

How New Jersey's Managed Long-Term Services and Supports Program Works

Before MLTSS, New Jersey paid providers directly for each long-term care expense for every Medicaid recipient. For example, the state would have sent payments to your nursing home and your home health aide separately.

With MLTSS, the state pays a fixed amount to private companies to manage the LTC needs of Medicaid recipients. To receive long-term care services, New Jersey Medicaid recipients must enroll with one of the NJ FamilyCare managed care organizations (MCOs) or the state's Program of All-Inclusive Care for the Elderly (PACE).

MLTSS emphasizes individual care coordination and provides 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 all the NJ Family Care medical benefits (like doctor's visits and medical testing) and all the following LTSS:

• 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 on the NJ FamilyCare website, and you can get help choosing an MCO by contacting your local Aging and Disability Resource Center. Or email your questions to the New Jersey DHS Division of Medical Assistance and Human Services.

New Jersey PACE

New Jersey also offers PACE (Program of All-inclusive Care for the Elderly). PACE is a federal program that provides comprehensive medical and social services to eligible Medicare and Medicaid recipients, helping them stay in their communities instead of moving to nursing homes. (42 C.F.R. § 460.)

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. But it's not available everywhere in New Jersey.

To qualify for PACE, you must have Medicare, Medicaid, or both, and you must:

• live in an area served by a PACE organization
• be at least 55 years old
• meet the nursing home level of care standard, and
• be able to live safely in the community (with PACE services) at the time you enroll.

To enroll in a PACE program, you must apply directly to the one you're considering, and they'll help determine if you're eligible. Medicaid will pay for PACE programs for individuals who qualify. Learn more about PACE from the New Jersey DHS Division of Aging Services.

Applying for Medicaid for Long-Term Care in New Jersey

To apply for Medicaid in New Jersey, contact your county Social Services Agency, call 800-356-1561, or contact your local Area Agency on Aging (AAA), which serves as your local Aging & Disability Resource Connection.

If you're already living in a nursing home or assisted living, the staff should be able to help you apply for Medicaid.