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Medicaid managed long term services and supports

A look at the differences between NJ FamilyCare and the Medicaid Managed Long Term Services and Supports (MLTSS) benefit

Medicaid benefits can be difficult to understand or manage. In New Jersey, Medicaid is meant to provide health insurance to financially eligible individuals who are elderly, blind, disabled, dependents, or pregnant.

Medicaid Managed Long Term Services and Supports (MLTSS), the program that NJELC mostly helps our clients with, covers many services, including home care, assisted living care, nursing home care, hospital visits, and prescriptions. Typically, a person is eligible to receive these benefits if they are a resident of New Jersey, a U.S. Citizen or qualified alien, and meet the financial and clinical requirements.

NJ FamilyCare is another government-funded health insurance program in New Jersey. This benefit provides affordable health insurance to residents who qualify; namely, those that do not have insurance provided by an employer.

While MLTSS falls under the NJ FamilyCare program and is coordinated through a managed care organization (MCO), it is designed for a specific purpose.

Here is a deeper look into these programs and how they may benefit you or a loved one.

NJ FamilyCare: Eligibility Requirements

Qualified NJ residents of any age can be eligible for NJ FamilyCare. This includes children, parents, caretaker relatives, and adults without dependent children. Eligibility is based on the income and household size that was reported on the applicant’s latest federal tax return.

MLTSS: Eligibility Requirements

The MLTSS benefit is meant to provide long-term comprehensive services for those with disabilities and low incomes. The program helps those who qualify to receive necessary convalescent and medical care that they would otherwise be unable to afford.

Types of long-term supports and services covered under the program are: home and vehicle modifications, personal emergency response systems, home care, assisted living or nursing home care, and care management planning.

Eligibility requirements for MLTSS benefits, according to New Jersey’s Disability Benefits 101 website, state that the individual must:

  • Live in New Jersey.
  • Be a U.S. citizen or a qualified alien.
  • Have a qualifying disability, be 65 or older, or be blind.
  • Qualify to enter a nursing home (though they do not have to live there).
    • This determination is based on an assessment by the New Jersey Office of Community Choice Options of physical and cognitive abilities.
  • Have resources available of $2,000 or less if an individual or $3,000 or less if a couple.
  • Have a maximum gross income less than $2,313/month (2019).

For those individuals under 65 to be deemed to have a qualifying disability or to be considered blind, the appropriate determination must be made by the Social Security Administration or by the Division of Medical Assistance and Health Services.

Those who meet the requirements of the MLTSS benefit are also eligible for NJ FamilyCare.

Those who are eligible to receive NJ FamilyCare in a nursing home have their care managed by an MCO through the MLTSS program. Also, individuals with Medicaid who are entering a nursing home for the first time will have their care managed by a Program of All-inclusive Care for the Elderly (PACE) or the NJ FamilyCare MCO with MLTSS.

Understanding these requirements and regulations can be difficult. If you have questions about your eligibility for the MLTSS benefit, we are here to help. At Elder Law Department at Goldberg Law Group at Goldberg Law Group, we assist our clients with Medicaid planning, so that those who need long-term care do not have to worry about the details. We know that long term care can be tough to manage for the entire family, which is why we strive to make this stage of life easier.

Get in touch with our experienced team today to learn more about how we can help you manage Medicaid planning.