Medicaid and MLTSS in New Jersey njelc

It’s important to understand the laws in New Jersey and how seniors have been affected

Medicaid is a federal government health coverage program that is administered at the state level. It requires that applicants meet certain eligibility requirements and guidelines. It’s also the largest payer of long-term care in the country. Millions of Americans require these long-term care services, and Medicaid provides long-term care services through Managed Long Term Services and Supports (MLTSS).

What follows is an overview of how MLTSS works in New Jersey, how the ACA impacted Medicaid, and how these changes affect the elderly.

How is MLTSS provided in New Jersey?

In New Jersey, MLTSS is provided by the NJ FamilyCare program and is coordinated through managed care organizations (MCOs). These programs are sometimes referred to as HMOs or health plans. MLTSS allows those in need of long-term care to have access to a variety of resources and services including home care services, assisted living facility care, community residential care, nursing home care, hospital visits, and prescriptions.

Comprehensive services are provided through MLTSS so that patients can remain in these support systems as long as possible. There are age, clinical, and financial requirements that a person must meet to be eligible for MLTSS in New Jersey. For example, a person must be 65 or older, or under 65 and determined to have a disability by the Social Security Administration or the State of New Jersey.

Patients who have Medicaid and are admitted to a nursing home have their care managed by the NJ FamilyCare MCOs with MLTSS or a Program of All-Inclusive Care for the Elderly program (PACE).

New Jersey chose the managed care approach to long-term care so that health care would be better coordinated and managed for patients.

How did the Affordable Care Act (ACA) impact the elderly in New Jersey?

Across the country, it’s estimated that 70 percent of people over age 65 will need long-term care. In 2017, total Medicaid spending in New Jersey was over $14 billion, and the fee-for-service long-term care costs were over $2.6 billion in the state.

In 2014, the ACA expanded Medicaid. This brought certain changes to MLTSS in New Jersey. New Jersey’s Department of Health integrated the Global Options (GO) for Long Term Supports Waiver into MLTSS, and those already on the program were incorporated into the managed care system. New patients were then enrolled in the program if they qualified for MLTSS.

An important additional change was the de facto abolishment of the Medicaid income cap in New Jersey. Through the use of a Qualified Income Trust, those otherwise eligible individuals who were deemed ineligible to receive Medicaid support services at home or in assisted living due to their “high” income are now eligible. While this change provides relief for those seniors who could qualify for Medicaid only in a nursing home under the prior rules, it also adds a level of complexity to the application process.

There’s no doubt that patients need long-term care, as enrollment continues to build and costs continue to rise. With MLTSS, seniors in need can enjoy the benefits of a coordinated care plan and receive care at home or live in long-term care facilities that they would not be able to afford otherwise.
If you have questions about MLTSS options for you or a loved one, don’t leave coverage and costs to chance. Get in touch with our team at Elder Law Department at Goldberg Law Group to meet with one of our Certified Elder Law Attorneys who will oversee the Medicaid application process and ensure you receive the best care possible. Contact us today to learn more about our services.