Does Medicaid Cover Assisted Living in NJ?
I'm not going to hold you in suspense – the short answer is yes. New Jersey Medicaid does cover assisted living. New Jersey Medicaid also covers in-home care through the same program as well as a couple of others (but that's another article).
Medicaid in New Jersey
Medicaid in NJ has undergone some really big changes in the last few years, and they are part of the reason that the programs seem so confusing.
The state recently transitioned its care from a state-managed system to one through so-called Managed Care Organizations, which is another way of describing those big health insurance companies that we all know about (and which I will not mention, since they don't pay me to do so).
The State has also moved back to an “income cap” structure, which it hadn't used since the 1990s. You may hear this referred to as “global options” or the “comprehensive waiver” program, but the question is the same.
What does this all mean?
If your loved one needs a nursing-home level of care (assistance with three “activities of daily living” such as transferring from a chair to a bed, feeding themselves, toileting, dressing themselves, and so on), or they have dementia, it should be fairly straightforward to qualify medically.
The financial criteria are the same as those we have described in prior articles – a single person can keep minimal assets, and a couple can keep more. If your loved one has income in excess of $2,199 a month (that's the number for 2015) they will need to have something called a “qualified income trust” or “Miller trust” set up.
The State has a template available and describes it in some (although not enough) detail. You will also need to make sure your loved one has not made any gifts in the last five years, and that the assisted living facility you choose will accept your loved one while he or she is on Medicaid.
Typically they will ask as a condition of admission that the person pays privately for at least two years prior to admission.
You are not alone
If this all sounds confusing and overwhelming, you're not alone. Medicaid qualification for a nursing home is complicated enough. The additional financial burdens and requirements on a family in an assisted living situation can be impossible to navigate correctly the first time around.
This is why elder law attorneys are such a valuable resource when considering a placement for your loved one in an assisted living setting – they have been through the process many times and know when the assisted living facilities are setting you up for failure.
They also know when the facilities are being fair, and when the county is going to pose a problem. Before you sign anything or even consider a placement, you should really call an elder law attorney and make sure they can guide you through the assisted living process and the application for assisted living Medicaid in New Jersey.
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