How many New Jersey Medicaid program are there?

As New Jersey elder law attorneys, we regularly work with the Medicaid programs that provide long term care benefits.  We categorize them as institutional Medicaid and community waiver Medicaid.  Institutional Medicaid covers long term care in a nursing home.  New Jersey is an “income cap state with a medically needy program”.  This means we have 2 institutional Medicaid programs.  The “Medicaid Only” program is for residents who have income that does not exceed the income cap (currently $2094 gross income per month in 2012).  For those with income greater than the income cap (even by $1), there is the Medically Needy program as long as income does not exceed the Medicaid reimbursement rate(the rate at which Medicaid pays for the resident’s care at the nursing home.  That rate generally ranges between $5000 and $6000 per month.

The community waiver programs that New Jersey elder law attorneys frequently work with have been rolled into a program called Global Options.  These programs include the Assisted Living Medicaid program and the home based Medicaid program.  There are many other smaller Medicaid programs that we very infrequently deal with.  It is important to understand that no 2 Medicaid programs are exactly alike as far as the rules and regulations are concerned.  There are many similarities.  However, there are also many differences.

One thing that is common to all New Jersey Medicaid programs is that Medicaid is a needs based program, meaning that one has to meet certain financial requirements in order to be eligible.  There is an income requirement and an asset requirement.

One more point to consider is that Medicaid is a combination federal/state program.  Congress passed some basic laws and has allotted money to New Jersey if it offers Medicaid to certain eligible residents.  The state must follow those basic rules but New Jersey has been left the responsibility of administering its own Medicaid programs.  It is also free to offer other Medicaid programs beyond what the federal government requires.

This has led to many variations from state to state when comparing Medicaid programs and how the rules are applied.  For example, New York’s Medicaid programs differ in very significant ways from New Jersey’s Medicaid programs.  Because the federal government provides no oversight to be sure that it’s rules are being followed, In some cases the states blatantly ignore those rules.  It is left to the elder law attorneys to challenge the State when it flagrantly disregards the clear law.

For more information, email us at contact@hauptmanlaw.com and type in  “Consumer’s Guide to New Jersey Medicaid” and we’ll email you our Consumer’s Guide in pdf format.