Will NJ Medicaid pay for my care at home?

Posted on: April 16th, 2018 by Mark R. Friedman

We get asked this question a lot. And the answer is maybe.

New Jersey Medicaid can pay for home health aides to come to your home and provide care to you. However, there are two caveats to that.

First, you may not get as many hours of home health care as you think you need. New Jersey has privatized its Medicaid program to some degree – instead of the state paying providers directly, the state makes payments to managed care organizations (MCO’s), which are health insurance companies like United Healthcare and Horizon NJ Health.

If you qualify for Medicaid and seek aides at home, the MCO will send out staff to evaluate your needs. It will award you a number of hours based on that assessment.

Here’s the thing. These are private insurance companies, and they are seeking a profit. They get a fixed payment from the state for each Medicaid beneficiary. So they make more money when they pay for fewer aide hours, and they lose money when they pay for more hours. The MCO has a natural incentive to award you as few hours as possible.

Typically, we see people get between twenty and fifty hours per week, with maybe thirty or forty being typical. That works out to around four to six hours per day, seven days a week. Or maybe seven or eight hours a day, five days a week. If that’s enough to meet your needs, then you may be a good candidate for home care with Medicaid.

To get it, you’ll have to qualify for Medicaid’s long term care (LTC) program. The LTC program has strict eligibility requirements. You must have less than $2,000 in assets. In addition, you’re required to submit five years’ worth of records for all financial accounts, and Medicaid staff will review those records to see if any gifts have been made. Any gifts that were made affect eligibility. Likewise, Medicaid will look to see if there are any hidden accounts. You also must meed medical eligibility requirements for the LTC program, and various other requirements.

There are a lot of moving parts to obtaining Medicaid. You may have to spend down your assets to get below $2,000, and you may want to do that in a way that’s least unfavorable to your spouse and children.

If you’re interested in having long term care Medicaid pay for home health aides, you may have questions regarding the Medicaid spend-down, and you may need help applying for Medicaid. FriedmanLaw is available for these issues. Call or email us today.

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Homepage photo: Cows grazing at Meadowbrook Farm, Bernardsville, NJ by Siddharth Mallya. October 23, 2012.
Interior photo: Somerset hills pastoral scene by Lawrence Friedman.