As discussed in a prior blog post, a major overhaul of Medicaid will be introduced in New Jersey in the coming months. The new Medicaid program is called Managed Long Term Services and Supports (MLTSS). The MLTSS implementation date has been repeatedly adjourned, and the next date scheduled to put the new program into effect is December 1, 2014. However, MLTSS cannot be implemented until the federal Centers for Medicare and Medicaid Services (CMS) has approved New Jersey’s plan, and the critical CMS approval has not yet been received by the State.

MLTSS refers to the delivery of long-term care services and supports through managed care organizations. In MLTSS arrangements, contractors receive capitated payments for long-term care services and are accountable for insuring the delivery of services and supports that meet quality and other standards. MLTSS is designed to promote community inclusion by expanding home and community-based services. As of October 2014, twenty-eight (28) states were operating MLTSS programs. In New Jersey, MLTSS uses NJ FamilyCare managed care organizations to coordinate ALL services.

New Jersey implemented its MLTSS program through a comprehensive Medicaid waiver permitted by CMS. The CMS waiver permits the States to develop Medicaid programs that differ from the standard federal Medicaid program. Under the waiver, New Jersey was able to expand Medicaid eligibility and coverage options for people who need home and community-based services but previously were not eligible for Medicaid due to excess income. Under the federal waiver, New Jersey has combined the following four pre-existing home and community- based programs: Global Options for Long-Term Care (GO); AIDS Community Care Alternatives Program (ACCAP); Community Resources for People with Disabilities (CRPD); and, Traumatic Brain Injury (TBI) Waiver.

MLTSS is designed to provide a comprehensive menu of services and supports across care settings, whether the elderly or disabled applicant lives at home, in an assisted living facility, in community residential services or in a nursing home. MLTSS includes services such as:

• Personal Care;
• Respite;
• Care Management;
• Home and Vehicle Modifications;
• Home Delivered Meals;
• Personal Emergency Response Systems;
• Mental Health and Addiction Services;
• Assisted Living;
• Community Residential Services; and
• Nursing Home Care.

To qualify for MLTSS, an applicant must meet the following three (3) NJ FamilyCare eligibility requirements:

(1) Financial Requirements–

       Income
Income for one person can be equal to or less than $2,163 per month in 2014, and income for a couple can be equal to orless than $4,326 per month in 2014. Applicants with income in excess of the income limits will be permitted to transfer excess income each month to a special type of trust called a Qualified Income Trust (QIT). Excess income placed in a QIT trust will not disqualify an individual applying for Medicaid benefits.

      Resources
Resources must be at or below $2,000 for an individual and $3,000 for a couple.

     Transfer of Assets Rules
Applicants may not transfer assets to anyone for less than fair market value within five (5) years of the application date.

For more detailed information on NJ FamilyCare financial eligibility, go to: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/abd/

(2) Clinical Requirements–

A person must meet the qualifications for nursing home level of care, which means that s/he must require assistance with activities of daily living such as bathing, toileting and mobility.

(3) Categorical Requirements–

These refer to the requirement that applicants must either be aged (65 years or older) or disabled (under 65 years of age and determined to be blind or disabled by the Social Security Administration or the State of New Jersey) in order to be eligible for benefits.

To get more information about managed care organizations who contract with NJ FamilyCare, applicants should call NJ FamilyCare at 1-866-472-5338.

For additional information concerning Medicaid and public benefits planning, visit:
https://vanarellilaw.com/medicaid-public-benefits-planning/