Date: January 22, 2024Attorney: Donald A. Dennison

New Jersey Family Care Overview

All Medicaid programs offered in New Jersey fall under the umbrella “NJ Family Care”. NJ Family Care consists of several different Medicaid programs, catering to both institutional services (nursing home and other long-term care facilities) and home and community-based services. Each Medicaid program has its own eligibility criteria, each of which may take into consideration the applicant’s income, resources (assets), disability status, or any combination thereof.

Eligibility for Home and Community-Based Services

On January 16, 2024, Governor Murphy signed into law Bill A4049/S3495, which provides for “presumptive eligibility” to individuals applying for (or intending to apply for) the home and community-based services program, as well as services through the program of all-inclusive care for the elderly. This historic legislation makes New Jersey one of only a few states that have adopted similar policies extending presumptive eligibility to home and community-based Medicaid applicants. We anticipate the roll-out of this new law will take some time, given the State’s need to secure federal financial participation.

Currently (as we await the implementation of this new legislation), an individual seeking Medicaid benefits through the home and community-based services program must first meet all eligibility criteria before submitting their Medicaid application to the applicable county welfare agency. Processing times vary from county to county, and even from application to application depending on the complexity of the individual’s circumstances. Those who have gone through this process know that it can and often does take several months before the county renders a decision (approval or denial) on the application. To make matters worse, the lengthy period between the submission of a Medicaid application and receipt of a decision from the county welfare agency can pose several risks to the Medicaid applicant due to their continued residence at home (sometimes without supports in place), limited financial resources (and/or income) and declining physical (and/or mental) health. The presence of these three risk factors can result in a “perfect storm”, especially if the individual is isolated from friends and family who cannot monitor their condition.

New Jersey Extending Medicaid Benefits

However, New Jersey will soon be extending full Medicaid benefits to individuals seeking enrollment in the home and community-based services program before their Medicaid application is submitted and processed (assuming certain conditions are met). In other words, county welfare agencies will now be able to make a conditional offer of benefits to home and community-based services applicants after only a superficial review of the applicant’s circumstances, provided the review results in a determination that the applicant is likely qualified to receive benefits. Under the new law, applicants who are presumed eligible will be expected to submit their Medicaid application (and required “proofs”) to the county welfare agency no later than the end of the month following the month in which presumptive eligibility is granted.

This new legislation seeks to bridge the “care gap” for many who wish to live out their later years at home rather than in a facility. The legislation also seeks to address some of the historic barriers to receiving Medicaid benefits in the community, a much-welcomed change in a post-pandemic world, where concerns about long-term care facilities are at an all-time high.

How We Can Help

If you or a loved one are considering applying for Medicaid through the home and community-based services program and would like to discuss pathways to eligibility, please contact the Elder Law Department at Mandelbaum Barrett to schedule a consultation with one of our elder law attorneys.