Augulis Law Firm, LLC– New Jersey Medicaid Guide
You may be one of the many people who makes it through their entire working years without ever having a need to qualify for Medicaid benefits, only to find that you need to qualify as a senior. The high cost of long-term care (LTC), coupled with the fact that neither your basic health insurance plan nor Medicare will cover LTC expenses, means that over half of all seniors needing nursing home care must rely on Medicaid to help with the cost of that care. If you have never before participated in the Medicaid program, you may find the program complicated to understand and the system difficult to navigate. To help you get started, the Medicaid planning attorneys at Augulis Law Firm, LLC created the following New Jersey Medicaid Guide. If you have specific questions or concerns about eligibility guidelines, please feel free to contact our office for a consultation.
Medicaid Basics – Understanding the Difference between Medicaid and Medicare
People often confuse Medicaid and Medicare, or use the two interchangeably. Although both are federally sponsored healthcare programs, the similarities stop there. Medicare is an entitlement program, meaning you will automatically be enrolled when you reach retirement age if you paid into the program over the course of your working years. Your income and assets are not considered for the purpose of enrollment in Medicare. Medicaid, on the other hand, is a “need based” program, meaning you must demonstrate a financial need to qualify for enrollment. Although Medicaid is primarily funded by the federal government, it is administered by the individual states. As such, there are some differences in eligibility criteria and benefits offered to participants from one state to the next. For seniors, one of the most important differences between Medicare and Medicaid is that Medicare will not cover long-term care (LTC) expenses except in very limited circumstances for a short period of time. Medicaid, on the other hand, does help pay for nursing home, and other LTC, expenses for applicants who qualify.
New Jersey Medicaid Categories
Like most states, New Jersey offers several different categories of Medicaid. An applicant must fit into one of the categories to be considered for benefits. The categories include:
- Families with dependent children — Children age 18 and younger may be eligible for NJ FamilyCare/Medicaid if their family’s total income before taxes is at or below 350 percent of the Federal Poverty Level. Parents may also be eligible if earned income is at or below 133 percent of the Federal Poverty Level.
- Pregnant women – Pregnant women may receive coverage if the household income is at or below 200 percent of the Federal Poverty Level. Coverage is for the term of the pregnancy and for 60 days after the birth.
- People who are 65 years of age or older, blind, or permanently disabled — New Jersey Medicaid offers a number of programs for the elderly and disabled that provide help with healthcare costs both in the community and in a long-term care setting.
Medicaid for Seniors in New Jersey
New Jersey offers several programs for seniors living on a low income. If you are 65 or older and receiving Supplemental Security Income (SSI) in New Jersey, you will automatically be eligible for Medicaid. If you do not receive SSI, but your income is at or below 100 percent of the Federal Poverty Level, you may qualify for New Jersey Care, Special Medicaid Programs. Low income Medicare recipients may qualify for the Medicare Savings Program which helps pay the monthly Medicare premium, co-pays, and deductibles. Finally, if you need nursing home care, or care in an assisted living community or your own home, you may qualify for Long Term Services and Support, or LTSS, which provides services such as personal care, home-delivered meals, and care management.
If your income and/or resources are too high to qualify for regular Medicaid, the Medically Needy Program may still be an option. The Medically Needy Program includes a “spend down” provision that allows documented medical expense to be used to reduce monthly income in order to meet eligibility limits.
Additional information about the various programs for the Aged, Blind, and Disabled (ABD), as well as information on what counts as income and resources, is available in an online booklet found on the New Jersey Department of Human Services website.
Are You Eligible for New Jersey Medicaid?
The eligibility requirements for New Jersey Medicaid will depend on the specific category and program for which you are applying. Most programs, however, include both an income and a “countable resources” limit. You must also be a be a resident of New Jersey and be a U.S. Citizen or qualified alien. Note that most immigrants who arrived after August 22, 1996 are barred from Medicaid for five years, but could be eligible for NJ FamilyCare and certain programs for pregnant women.
Applying for Medicaid in New Jersey
If you are applying for any of the New Jersey Medicaid of the Aged programs, you may wish to look over the Income, Resources, and Documentation Checklist first to make sure you have everything ready. All Medicaid for the Aged programs use the same application which is include in a booklet found on Medicaid’s website. After you complete the application, it must be mailed in and it will be evaluated by an eligibility processor. If you need help completing the application, you can make an appointment at one of the county offices.
Why Is Medicaid Planning So Important?
Most Medicaid programs for seniors have a “countable resources” limit that is extremely low. If the value of your resources (assets) exceeds that limit you will not be eligible for Medicaid benefits. Moreover, Medicaid uses a five-year look-back rule that allows the program to review your finances for the five-year period prior to your application. Any asset transfers for less than fair market value may be disqualified and the value of the asset imputed back into your estate for the purpose of determining your eligibility for Medicaid. Because you cannot transfer assets for the five-year period leading up to your need to qualify for Medicaid, you need to plan ahead by including Medicaid planning in your estate plan early on.
If you have additional questions about New Jersey Medicaid, contact the experienced New Jersey Medicaid planning lawyers at Augulis Law Firm, LLC by calling 908-222-8803 to schedule your appointment today.