By Fredrick P. Niemann, Esq. of Hanlon Niemann Wright, a Freehold, NJ Special Needs Trust Attorney

The NJ Department of Human Services characterizes the Medicaid eligibility process as complex. It notes that each program must be “evaluated according to an applicant’s individual circumstances.”  I can tell you from experience Medicaid Eligibility is more than complex. When you try and go through the various government resources intended to provide general information to the public about Medicaid programs, it is clear that the government deliberately chooses not to specify what conditions or other factors make one eligible or ineligible. One program with vague and impressive operating standard is MLTSS aka (Medicaid Long Term Support Services).

 

The MLTSS program supports the following: Benefits and Services, Case Personal Care; Respite; Personal Emergency Response System (PERS), Home and Vehicle Modifications; Home Delivered Meals; Assisted Living; Behavioral Health Services; Community Residential Services; and Nursing Home Care

 

Since July 1, 2014, special needs individuals eligible for MLTSS who wish to receive MLTSS benefits must disenroll from their Dual Eligible Special Needs Plan. Then these are the options:

1. Return to original Medicare and a Medicare Part D Drug Plan, with NJ

Family Care services handled by the same MCO that offered their D-SNP

coverage

2. Return to original Medicare and a Par D Drug Plan, with NJ FamilyCare

services handled by another MCO.

3. Enroll in a Medicare Advantage plan with drug coverage, with NJ

FamilyCare services handled by the same MCO that offered their D-SNP

coverage.

4. Enroll in a Medicare Advantage plan with drug coverage, with NJ

Family Care services handled by another MCO

5. Enrollment in a PACE program.

 

For NJ FamilyCare MLTSS eligibility, you must continuously meet the following three criteria:

1. Categorical
2. Aged – 65 or older
3. Blind or Disabled – Under 65 years of age determined blind or

disabled by the Social Security Administration or the State of  NJ.

2. Clinical
3. Must meet clinical eligibility criteria established by state of NJ – this

is a case-by-case basis – a state worker will determine what one can do

and  not do after an assessment.

3. Financial
4. For one person income must be less than or equal to 2,163 per month
5. Income for a couple can be equal or less than 4,326 per month
6. All income is based on the gross amount

 

In order to enter the MLTSS system, a potential new enrollee must do the following:

1. Contact the local Aging and Disability Resource Connection (ADRC) for

information, assistance and screening.

2. Contact County Welfare Agency to apply for Medicaid

 

MLTSS Choices:

If you have NJ FamilyCare only:

1. NJ FamilyCare Organization (MCO)
2. Program of All-Inclusive Care for the Elderly (PACE)

 

If you have NJ FamilyCare and Medicare:

1. MCO plus Medicare plan(s)
2. PACE

 

If one chooses MCO, one must enroll in one of the NJ FamilyCare  Organizations:

1. Amerigroup New Jersey INC.
2. Horizon NJ Health
3. UnitedHealthcare Community Plan
4. WellCare Health Plans of New Jersey

 

If one chooses PACE there are few things to know:

àIt provides all services including nursing facility care, if needed

àYou must be 55 or older, able to live safely in the community at the time of enrollment and have care needs at a nursing home level.

àMust live in the county of the PACE organization

1. Life at Lourdes – Camden County
2. Lutheran Senior LIFE – parts of Hudson County
3. LIFE St. Francis – Mercer County and northern Burlington County
4. Inspira LIFE – Serving Cumberland and parts of Gloucester and Salem

counties

1. PACE – parts of Monmouth County and Ocean County

 

To discuss your NJ special needs trust or Medicaid eligibility matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing consultations if you are unable to come to our office.