In New Jersey, long-term care in a nursing home, assisted living facility or even at-home care is of the highest in the country. In 2015, the average daily cost of a semi-private room in a nursing home in New Jersey was $325. Health insurance and Medicare don't cover long term care, and few people purchase long-term care insurance. That's leaves Medicaid. Medicaid is a very common source of funding for long-term care in New Jersey, particularly when people have already used up all of their own assets to pay for care. In fact, most long-term nursing home residents use Medicaid to pay for their nursing home care.
There are many different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services. We'll go over eligibility rules for nursing homes below. (Also read our article on when New Jersey Medicaid will pay for assisted living or home health care.)
To get an application for Medicaid in New Jersey, contact the Board of Social Services in the county where you live or your local Aging and Disability Resource Center.
Medicaid's Income Limit for Long-Term Care in New Jersey
New Jersey residents who are 65 or older (or disabled or blind) can qualify for Medicaid if they meet certain income and asset limits. If you receive SSI, you already qualify to receive Medicaid in New Jersey. There is a higher income limit for seniors (and disabled or blind folks) who need care in a nursing home, assisted living or home health services. If you are 65 or older, blind, or disabled, you can qualify for Medicaid long-term care services as long as the monthly income [for the applicant] is no more than $2,199 per month for 2015*. If your income is higher our expert Medicaid Planning and Elder Law attorneys in New Jersey can still get you qualified. If there is a spouse, the income limits are counted differently. [*see end of post]
Resource Limit for Long-Term Care in New Jersey
You must have few resources (such as money and property) in order to qualify financially for Medicaid, your resource limit as an individual is $2,000* if there is a spouse, the resources are counted differently and the spouse can retain as much as $119,220 [*see end of post].
Not all property counts toward the resource limit. In New Jersey the following items are not counted
- the applicants home, provided it is the principal place of residence.
- personal belongings and household goods
- income producing real estate
- one vehicle
- burial spaces and certain related items
- up to $1,500 in any designated [revocable or accessible] fund
- any irrevocable burial trust or fund [up to $15,000]
- life insurance if face value is less than $1,500 or there is no cash value
When a Nursing Home Is Medically Necessary
In addition to only paying for those with low income and assets, Medicaid will pay for a nursing home only when it is medically necessary. You must show that you need a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with several activities of daily living (ADLs) like bathing, dressing, toilet use, transfer, locomotion, and eating. In other words, you must show that you cannot care for yourself
In addition to only paying for those with low income and assets, Medicaid will pay for a nursing home only when it is medically necessary. You must show that you need a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with several activities of daily living (ADLs) like bathing, dressing, toilet use, transfer, locomotion, and eating. In other words, you must show that you cannot care for yourself
Before Medicaid will pay for nursing home care, you must have a "pre-admission screening." In New Jersey, pre-admission screening is done by teams from one of three Long-Term Care Field Offices for the Office of Community Choice Options. Screenings are usually done by nurses or social workers who visit you wherever you are living when you apply for help. The screener will ask questions to determine whether you need help with your ADLs.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. Medicaid also assesses whether you could stay in your home or in a community-based setting if you got supportive services. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. Medicaid also assesses whether you could stay in your home or in a community-based setting if you got supportive services. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Why should I seek legal advice about Medicaid planning?
It is extremely important to obtain qualified legal advice for Medicaid planning in New Jersey if your parents or loved one is applying for Medicaid. The cost to pay for nursing homes and for assisted living care centers is outrageous plain and simple. For many middle class people 1 or 2 years in a nursing home will wipe out most if not all of their nest eggs. Most people can't afford to pay for these expenses.
There are many complicated requirements that must be satisfied before a person will become eligible for Medicaid in New jersey. To qualify for Medicaid an applicant is required to pass certain tests on the amount of income and assets you have. The main legal concept of Medicaid is that the applicant must use the bulk of his own assets to pay for a nursing home before the Medicaid will pick up the tab. Therefore, it is very important to undertake careful Medicaid planning in New Jersey to try to save as much of your family's nest egg. Moreover, the Medicaid rules are a maze of confusion and of endless legalities. In summary, in most all instances our experienced Medicaid planning and elder law attorneys in will be able to save your family a lot of aggravation and most if not all of your family's savings and home by providing you with expert legal counseling on Medicaid planning in New Jersey
It is extremely important to obtain qualified legal advice for Medicaid planning in New Jersey if your parents or loved one is applying for Medicaid. The cost to pay for nursing homes and for assisted living care centers is outrageous plain and simple. For many middle class people 1 or 2 years in a nursing home will wipe out most if not all of their nest eggs. Most people can't afford to pay for these expenses.
There are many complicated requirements that must be satisfied before a person will become eligible for Medicaid in New jersey. To qualify for Medicaid an applicant is required to pass certain tests on the amount of income and assets you have. The main legal concept of Medicaid is that the applicant must use the bulk of his own assets to pay for a nursing home before the Medicaid will pick up the tab. Therefore, it is very important to undertake careful Medicaid planning in New Jersey to try to save as much of your family's nest egg. Moreover, the Medicaid rules are a maze of confusion and of endless legalities. In summary, in most all instances our experienced Medicaid planning and elder law attorneys in will be able to save your family a lot of aggravation and most if not all of your family's savings and home by providing you with expert legal counseling on Medicaid planning in New Jersey
* There are strategies and tools available allowing you to still qualify even if your income and resources are above the limits stated.
Medicaid rules are complex and confusing. Contact us today for expert Medicaid planning and application processing services in New Jersey, Philadelphia Pennsylvania and Baltimore Maryland.
Medicaid rules are complex and confusing. Contact us today for expert Medicaid planning and application processing services in New Jersey, Philadelphia Pennsylvania and Baltimore Maryland.
