The decisions you make now can affect your ability to receive adequate care later. Even if you’re healthy and feel like your future needs are accounted for, it’s important to plan and prepare so that you can qualify for Medicaid when you need it—the only government program that will pay for your long-term care if and when you can no longer afford to do so yourself.
There’s a lot of information out there. Between family, friends, and the internet, you’ve probably heard many different and conflicting bits of information about Medicaid. To maximize your chances of successfully qualifying for New Jersey Medicaid, you want to be sure you’re getting the facts you need. Keep reading to learn everything you need to know about how it works and what you can do to apply.
What is the New Jersey Medicaid program?
New Jersey Medicaid—also known as New Jersey FamilyCare—provides critical health insurance support to financially eligible individuals who meet certain requirements such as those who are pregnant, elderly, blind, have a disability, or are part of a family with dependents.
Enrollees will need to choose a managed care organization (MCO) or a health plan for their coverage. These include providers such as Aetna, Amerigroup, Horizon Blue Cross Blue Shield of New Jersey, United Healthcare, and WellCare of New Jersey.
Certain Medicaid programs will pay for healthcare needs including hospital visits, prescriptions, and nursing home care. New Jersey Elder Law Center offers guidance for applying for Medicaid Managed Long Term Services and Supports (MLTSS), a program designed to provide comprehensive long-term services for those with disabilities and low incomes.
MLTSS benefits include:
- Home care
- Assisted living care
- Nursing home care
- Respite care
- Home delivered meals
- Home and vehicle modifications
- Mental health and addiction services
- Access to all New Jersey FamilyCare Plan A Benefits
Who is eligible for New Jersey Medicaid?
New Jersey Medicaid/FamilyCare eligibility requirements include:
- Being a U.S. citizen and resident of New Jersey
- Meeting financial income requirements
MLTSS eligibility requirements
Those who meet the above-mentioned requirements may be able to access MLTSS benefits if they also require assistance with certain daily activities like bathing, getting dressed, eating, and moving from place to place. They must also be at or below specified asset and income thresholds—even if paying for long-term care out-of-pocket would quickly deplete their savings.
With the proper planning and the help of an experienced Medicaid and elder law team, however, individuals above the asset and income threshold may be able to qualify for the Medicaid assistance they need.
How to apply for New Jersey Medicaid
You can begin the New Jersey Medicaid/FamilyCare application process in one of two ways:
Some counties may also provide the option to apply in person. No matter how you apply, you will need documentation verifying your identity, age, citizenship, marital status, residency, ownership, income, and physical or medical eligibility.
While it may be tempting to apply on your own, most situations require legal guidance. Also, unless the applicant is already impoverished, there is almost always an opportunity to save money with proper guidance.
How long does it take to process Medicaid applications?
The time it takes to process your application can vary depending on which county you live in. In some counties, this can happen within 90-150 days, while in others it can take six months to a year. In some circumstances, the application process may take even longer.
Can I still apply for Medicaid after entering long-term care?
The need for long-term care can catch people by surprise sometimes. If you or a loved one finds yourself needing to enter long-term care before you had planned on it, you have options.
It is still possible to apply for Medicaid after being admitted to a nursing home, but it’s important to take quick action. Moreover, while the application is pending, you or your loved one must pay the nursing home from the applicant’s income. Once approved, Medicaid will pay the nursing home retroactively according to the eligibility date. Applying for Medicaid in assisted living is more complicated as the facility may ask for full payment while a Medicaid application is pending.
What can I do if my Medicaid application is denied?
If your Medicaid application is denied, you have options. Depending on the reason for the denial—which will be explicitly stated—you may be able to re-apply. For example, if the evidence you provided was insufficient, you will be given a list of appropriate documents to submit instead.
You also have the right to request a fair hearing before an administrative law judge. Note that in either scenario, you will need to act quickly.
Medicaid penalties and pitfalls to be aware of
- Exceeding the income or asset threshold
- Reducing countable assets with gifts/giving monetary gifts at the wrong time
- Paying for care without proper documentation
- Waiting too long to apply
- Selling the primary residence prior to applying
- Misunderstanding application rules and eligibility requirements
Applying for Medicaid can be a complicated process. When in doubt, it’s always a good idea to navigate the process with an experienced Medicaid and elder law team.
Get support from our legal team
By planning ahead now, you’ll have more peace of mind later. Our legal team has years of experience developing strategies, answering questions, and ultimately making the complex process of applying for Medicaid as stress-free as possible.
New Jersey Elder Law Center works with clients to provide:
- Strategic long-term care planning
- Medicaid application assistance
- Ongoing legal guidance
- Help with navigating Medicaid and the long-term care system
- A proactive approach to helping clients maintain Medicaid eligibility
New Jersey regulations may change from year to year, but our legal team stays current on all developments, keeping an eye on the details of those ever-changing policies. We can guide you and your loved ones accordingly. Contact us today to schedule a free consultation.