Long Term Care Medicaid (MLTSS)
Long Term Care Medicaid is a joint federal and state program for individuals with chronic illnesses, disabilities, or cognitive disorders who cannot care for themselves.
New Jersey’s LTC Medicaid is operated by the Managed Long Term Services and Supports (MLTSS) program. Delivered as part of NJ FamilyCare, MLTSS coordinates all services through designated Managed Care Organizations (MCOs), also known as HMOs or health plans. The program’s core objective is to provide a comprehensive support system that enables patients to maintain an independent life in a familiar environment for as long as possible.
Key Covered Services
- Home Care Services: Household assistance and personal care services provided at the patient’s residence.
- Community Residential Care: Support for admission to Assisted Living facilities and community-based residential facilities.
- Nursing Home Care: Coverage for professional skilled nursing facility (Nursing Home) admission and intensive care.
- Medical Services: Hospital visits, specialist consultations, and prescription drug support.
- Other Support: Connections to customized long-term care resources based on the patient’s specific condition.
LTC Management Systems
When a Medicaid beneficiary requires nursing home admission or long-term care, services are managed through one of the following two pathways:
- NJ FamilyCare MCO: Services are managed via selected health plans, where a care manager establishes a personalized care plan.
- PACE (Program of All-Inclusive Care for the Elderly): A one-stop integrated program for seniors aged 55+, providing medical and long-term care while prioritizing community living.
Eligibility
*For higher income, use a Qualified Income Trust (QIT) to meet the eligibility.
*Countable Assets: Includes cash, checking/savings accounts, stocks, bonds, and secondary properties.
*Excluded Assets: primary residence, one vehicle, and certain prepaid funeral arrangements are not counted toward the $2,000 limit.
*Couple both applying have different financial requirements.
The Asset Look-back Period
The most rigorous part of the application is the Asset Look-back Period. The state verifies if assets were improperly transferred to qualify for Medicaid.
- Cash Withdrawal Prohibition: Unexplained high-value cash withdrawals (generally over $500) in 5-year bank records are often flagged as ‘gifts.’
- Importance of Records: Every spend-down expenditure must be backed by receipts and contracts to avoid being judged as an improper transfer.
- Expert Consultation: Medicaid rules are complex. Consulting an Elder Law Attorney is the safest way to manage high-value assets.
Application Checklist
Essential Basic Proof Documents
- Identification: Citizenship certificate, birth certificate, or Permanent Resident Card (I-551).
- Residence: Utility bills or lease agreements showing the current residence address.
- Social Security: Copy of the Social Security Card and current health insurance cards (Medicaid, etc.).
Income and Asset Proof Documents (5-Year Records)
- Income: Benefit verification letters from the SSA, pension records, and proof of all rental or interest income.
- Financials: Full bank statements for the last 60 months for all accounts, including closed or zero-balance accounts.
- Property: Property tax bills, mortgage info, life insurance policies (cash value), and vehicle titles.
Clinical and Legal Documents
- Disability: Official determination letters from the SSA for applicants under 65.
- Legal: Power of Attorney (POA) or guardianship documents, and fair market value proof for any asset movements.
Legal Asset Spend-down Strategies for Eligibility
If assets exceed the $2,000 limit, applicants may use qualified expenditures to reduce assets to the required level legally.
Modernization of Personal and Household Assets
- Debt Repayment: Prioritize the payment of mortgages, credit card debts, unpaid taxes, and other legal loans.
- Home Improvement: Necessary repairs such as roof fixing, wheelchair ramp installation, or replacing old appliances in the primary residence.
- Medical Equipment: Purchasing devices not covered by insurance, such as specialized beds, wheelchairs, or hearing aids.
Irrevocable Pre-paid Funeral Contracts
Funds deposited into an Irrevocable Prepaid Funeral Trust—typically around $15,000 to cover standard funeral expenses—are excluded from Medicaid asset calculations, provided they are supported by a detailed statement of goods and services.
- Depositing excessive sums—specifically amounts exceeding $20,000 to $30,000—may be flagged as an attempt to “shield” assets and may trigger a Medicaid investigation or audit.
- It is recommended to consult with a licensed funeral professional or an Elder Law Attorney before finalizing any irrevocable contracts.
Payment for Professional Services
Fees paid for legal services (estate planning), accounting, and Medicaid application assistance are considered valid spend-down expenses.
How to Apply
- Contact your local Aging and Disability Resource Connection (ADRC) to request an MLTSS application. Simultaneously, apply for financial eligibility (Medicaid) through the Board of Social Services. They will verify if your income and assets meet the required criteria.
- A Managed Care Organization (MCO) representative will visit your home for a clinical assessment. They will evaluate your functional needs, such as how much assistance you require with Activities of Daily Living (ADLs), including bathing, dressing, and mobility.
- Select a health insurance plan. Once you have cleared both the clinical and financial screenings, you will choose an MCO. Options include: Horizon, UnitedHealthcare, Aetna, etc. *The online application (NJ FamilyCare/quickstart) only addresses the Financial Screening. The ADRC consultation and the Clinical Assessment must be coordinated separately. *If you are already enrolled in NJ FamilyCare please contact your MCO’s directly to request an MLTSS clinical assessment, rather than contacting your county ADRC.
Contact
- Long-Term Care Medicaid (MLTSS): Contact your local Aging and Disability Resource Connection (ADRC) and the Board of Social Services.
- Bergen County Division of Senior Services
- Address: One Bergen County Plaza, 2nd Floor, Hackensack, NJ 07601
- Phone: 201-336-7400
- Email: seniors@bergencountynj.gov
- Bergen County Board of Social Services
- Address: 218 Route 17 North, Rochelle Park, NJ 07662
- Phone: 201-368-4200
- NJ ADRC Statewide Toll-Free Number: 1-877-222-3737
- AWCA can provide counseling free of charge (201-862-1665 / info@awcanj.org).
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