If you’re wondering how to use Medicaid for elder care, whether it’s at home, in assisted living, or in a nursing home, you’re not alone. 

Medicaid is a federal program that delivers essential healthcare and long-term care benefits for individuals. But because it’s administered at a state level, it can be tricky to navigate both what the program offers and the eligibility requirements, especially when it comes to getting care in different living situations. 

No one should have to struggle to get the care they need. Our legal team at the Elder Law Department at Goldberg Law Group can help you understand your options and how to meet and maintain your Medicaid eligibility so you can get the care you deserve—wherever you are. 

What is Medicaid’s Managed Long Term Support and Services?

If you are interested in using Medicaid for long-term care, you will most likely go through Medicaid’s Managed Long Term Support and Services (MLTSS). MLTSS provides long-term services through the state’s FamilyCare managed care program. 

The program allows for a greater reach of home and community-based services and promotes inclusion, quality, and efficiency, according to the New Jersey Division of Medical Assistance and Health Services. MLTSS allows any long-term service to support a resident in the community or in a qualifying facility, for as long as possible.

MLTSS eligibility requirements

To receive MLTSS, New Jersey residents must meet these requirements:

  • A person must be either 65 or older, or 
  • Be under 65 and have been determined to be blind or disabled by the state or the Social Security Administration
  • Meet requirements regarding income and assets
  • Require assistance with daily activities, such as bathing, dressing, or mobility

Depending on the individual’s needs and wishes, they can qualify for support towards at-home services, assisted living, or a nursing home.

Medicaid at home

If a person qualifies for MLTSS and does not live in a nursing home or assisted living facility, they may be able to use their coverage to support services required for home care. 

Depending on the needs that must be met, home care services can be limited. For this reason, they may not work well for individuals who require 24/7 care. 

Home care service coverage could include:

  • Vehicle modifications
  • Home modifications
  • Meal delivery
  • Personal emergency response systems
  • Personal assistance

One of the benefits of MLTSS at home is that participants are able to self-direct certain care, such as personal assistance or homemaker services. This means that an individual could hire a person of their choosing, such as a child or spouse. While home care can increase the care recipient’s level of comfort, they should get proper advice to ensure that their needs are met.

If someone requires more frequent or more intensive care, then assisted living facilities or nursing homes may be the right choice depending on the circumstances.

Medicaid with assisted living

Assisted living is a great middle-ground for a person who needs a little extra care than at-home support can provide. 

These communities offer comfort and care while still giving residents independence. Often, residents have their own apartments and can prepare meals and have guests over as they wish. These facilities may offer group activities and a sense of community, which can help with the cognitive and social risks of aging. Some facilities do have certain visiting hours, though, which are meant as a safety precaution for other residents.

Assisted living facilities typically offer 24/7 access to care staff. Staff can also distribute daily medications and assist with tasks like bathing or changing.

Medicaid’s MLTSS covers residents in assisted living facilities who meet the clinical eligibility requirements. Additionally, the specific facility must accept Medicaid and have a Medicaid bed available. Each facility has its own specific conditions for admission. It’s essential to check with each facility to understand their specific policies and thoroughly research the quality and reputation of a facility before moving forward.

Importantly, most assisted living facilities in New Jersey accept Medicaid. One must not feel they need to enter into an inferior care environment to receive Medicaid in assisted living.  However, there are many traps for the unwary.  We are glad to discuss the various planning strategies available to allow you to qualify for Medicaid in assisted living.

Medicaid in a nursing home

Nursing homes focus on providing medical care, while assisted living communities generally provide less care and focus more on housing and support

Residents in nursing homes can expect smaller accommodations, such as a room and bathroom, rather than an entire apartment to manage. 

Because nursing homes provide more care, they tend to be more expensive care facilities. Nursing facilities have a larger support staff and multiple nursing stations to help patients who need intensive daily care. 

MLTSS covers nursing home care for qualifying individuals who have NJ FamilyCare, which is a federal- and state-funded health insurance program. NJFamilyCare then manages nursing home costs and healthcare through MLTSS.

If a loved one requires nursing home-level care, or if they have dementia, it can be fairly straightforward to qualify medically for MLTSS. Similar to assisted living, if your loved one has an income above a certain threshold, they may need to set up something called a “qualified income trust” or “Miller trust.”

Both nursing facilities and assisted living communities have staff on hand in case something happens to a patient at any time of the day or night.  

Applying for Medicaid can be a complicated and emotional process as you explore the best option for your family and their changing healthcare needs. The rules for Medicaid eligibility vary by state, household size, and year. No matter where you are at in the process, contact us. We can help you navigate Medicaid to arrive at the right choice for your circumstances.

Our team has years of experience in preparing our clients for the option to use Medicaid in the future and applying for Medicaid benefits when a party is qualified. Our clients rest easy knowing they will have an experienced team by their side for many years, one that can help develop strategies, answer questions, address concerns, and assuage any fears. For both those who have planned with us and those who need a plan now, our team is available to make filing for Medicaid as seamless as possible.

In a short, complimentary meeting, our attorneys and staff members can answer your questions about Medicaid and help you develop a plan that both protects your finances and accommodates your healthcare needs. 
Contact us to find out how we can help with Medicaid planning.