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NJ Community Medicaid New Jersey Care – Special Medicaid Program

The State of New Jersey currently has two different Community Medicaid programs to assist seniors aged 65 or above, the disabled, and blind with the staggering health costs associated with their care. Designed to fill in the wide and significant gaps in Medicare coverage, both programs allow those with limited resources to receive the healthcare they need without entering an institution.


This program essentially offers an exceedingly comprehensive health insurance plan with coverage benefits far exceeding those offered by traditional Medicare. It picks up the pricey Medicare part B premiums and covers prescription drugs;it does not however, provide long term care coverage for those who require ongoing assistance performing everyday tasks.


Who Qualifies for NJ community Medicaid

New Jersey Special Medicaid is available to residents of NJ who are:

• 65 years of age, or blind, or disabled

• Financially eligible


Financial Requirements

A single person receiving NJ Special Medicaid can retain a monthly income of $973.00, and up to $4,000.00worth of non exempt assets.

Look Back Period

Unlike with the Global Options Program (discussed below) applicants on the Special Medicaid Program are not subject to an audit of 5 years worth of financial history, and are only subject to a one month lookback period. Additionally only minimal financial records are requested

Pre Admission Screening

Because NJ Care/Special Medicaid does not provide long term care coverage, there is no pre-screening to determine the level of functionality. If an applicant meets criteria of being 65 years of age, blind, or disabled and meet the financial requirements- they are eligible.



Global Options /Home and Community Based Services Waivers


Global Options HCBS waivers are for NJ applicants that clinically require the level of care typically offered by a skilled nursing facility, but choose to remain in the community, and enjoy all the amenities associated with agingin place. While there is no 24 hour care, Global Options offers a variety of services that are designed to help the family keep a loved one home for as long as possible. Benefits include up to 40 hours with a home health aide (usually less), adult day care centers, assisted living options, durable medical equipment, moderate home modifications, and transportation to and from medical appointments, among more standard coverage.


Who Qualifies for NJ Global Option HCBS Waivers

NJ Global Option waivers are available to NJ residents who are:

• 65 years of age, or blind, or disabled

• Financially eligible

• Clinically Eligible


Financial Requirements

To qualify for the Global Option program, an individual can retain no more than $2,199.00 in income, and up to $2,000.00 worth of non exempt assets.

Look Back Period

Medicaid reserves the right to look back at 5 years worth of bank statements and financial history to ensure that no money was transferred or given away to meet the eligibility criteria. If they do in fact find such a transfer or gift within five years of the application, they will impose a penalty of ineligibility corresponding to the amount of money gifted.

Dealing with Surplus

If one does not meet the financial eligibility requirements there are some options available.

Qualified Income Trust aka Miller Trust: As of Dec. 1st 2014, if an applicant’s income exceeds the $2,199.00 limit, they can deposit the excess income into a qualified income trust where it will then be used to pay Medicaid providers.

For example, if an applicant has a monthly income of $3,000.00 , they can still qualify for the global options HCBS waivers so long as they deposit the surplus of $801.00 into a properly executed Qualified Income Trust.

Spend Down: If an applicant’s assets exceed the $2,000.00 threshold, they can spend them down until they make the asset threshold. Recognized spend down purchases include a Prepaid Irrevocable Funeral Trust, a burial plot, medical equipment that is not covered by Medicaid, and some personal care items.

Pre Admission Screening

To ascertain medical eligibility, Medicaid sends down a nurse to do an evaluation. If the applicant has trouble performing 3 or more ADLs he/she is considered in need of long term care, and would be medically eligible.

What Senior Planning Services can do

At Senior Planning Services, we take care of every aspect of the Medicaid application process from the initial consultation through the final approval. Because Medicaid is what we do , all day, every day, we have unparalleled expertise in navigating the system as well as exclusive resources and contacts within the board of social services. Individual caseworkers handle everything down to the minutest details, and are available at all times to answer questions and provide updates.

Senior Planning Services we:

• Are multilingual and speak your language

• Guide families through the spend down process

• Assist in obtaining 60 months of bank and financial statements from financial institutions back offices.

• Assist in obtaining verifications from banks regarding checks, deposits, and cash withdrawals

• Assist families in utilizing excludable resources

• Help liquidate life insurance policies, annuities and stocks etc.

• Obtain missing documentation from Vital Statistics, if necessary

• Represent our clients in the Medicaid Offices

• Prevent unnecessary denials by submitting correctly completed applications

• Facilitate expedited approvals


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