what does mltss cover

Learn what MLTSS covers in New Jersey and whether or not you’re eligible

While Medicaid is a federal program, it is administered at the state level. So, it is important to understand what the program requires and offers in New Jersey. If you are eligible to receive Medicaid Managed Long Term Support and Services (MLTSS), the next step is determining if it provides everything for your healthcare needs. This article will take a look at what MLTSS is and what it covers in New Jersey.


What is Medicaid Managed Long Term Services and Supports?

MLTSS provides long-term services through the state’s FamilyCare managed care program. These long-term services allow greater reach of home and community-based services and promote inclusion, quality, and efficiency, according to the New Jersey Department of Human Services, 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.


Who is eligible for MLTSS?

There are certain requirements that New Jersey residents must meet to receive MLTSS. First, a person must require assistance with daily activities that meet nursing home qualifications, such as help with bathing, dressing, toileting, transferring, feeding oneself, or mobility. Then, financial information must be provided that shows the requirements for eligibility are met.


There are also age and disability requirements. A person must either be 65 or older or be under 65 and have been determined to be blind or disabled by the state of New Jersey or the Social Security Administration.


Nursing home care and assisted living

MLTSS covers nursing home care for qualifying individuals who have NJ FamilyCare. The nursing home and primary health care are then managed by a NJ FamilyCare managed care organization (MCO) through MLTSS.


MLTSS also covers residents in assisted living facilities who meet the clinical eligibility requirements. The assisted living facility must both accept Medicaid and have a Medicaid bed available.


Home care services

If a person who qualifies for MLTSS does not live in a nursing home or assisted living facility, this coverage may also apply to comprehensive services and supports that are required for home care. Home care services are limited and may not work well for individuals who require 24/7 care.


Home and vehicle modifications

If the elderly or disabled patient requires that his or her environment be altered to meet the needs of his or her condition, MLTSS will cover necessary home and vehicle modifications.


Mental health services

Mental health services are covered by MLTSS, as well. These can include mental health conditions or necessary addiction treatments and services.


Respite care and care management

MLTSS covers respite care and care management. Each individual under MLTSS has a care manager and a team overseeing his or her care. This team generally consists of social workers or nurses, and they help with daily needs and monitoring and creating a care management plan for the patient.


Personal emergency response systems

A benefit of living in a community or nursing home is that these facilities provide emergency response systems in case something happens in a patient’s apartment or room. These devices could be a call button that a patient wears or even a system of sensors that track the person’s movement throughout his or her home. Sometimes these smart devices even monitor vital signs and medical data. These systems are covered under MLTSS.

Navigating MLTSS coverage and determining eligibility can be difficult and confusing for many people. Our attorneys at Elder Law Department at Goldberg Law Group at Goldberg Law Group can provide you with expert advice about MLTSS and help you understand what is and is not covered more extensively. Contact us to find out how we can help with Medicaid planning.