THE NEW JERSEY MEDICAID APPLICATION PROCESS
Although practice differs slightly from county to county, the basic format is relatively the same.
An request for Nursing Home Medicaid is filed with the County Board of Social Services where the loved one is receiving his/her long-term care. Some counties may have more than once office located in their jurisdiction.
The County Medicaid Office summons the loved one's agent to attend an intake conference. Unlike other states, NJ will not send a written application prior to the intake conference. Instead, the Medicaid caseworker essentially completes the application at this interview.
In order to expedite this Medicaid application process we have obtained the form that the counties use. We will help you complete this application in advance of the initial intake conference. We will also help you gather the supporting materials and documentation. We will attend the intake conference with you and systematically present the caseworker with everything which is required.
Married Couples With An At-Home Healthy Spouse:
Note that when there is an at-home community spouse, Medicaid will determine how much the at-home spouse will be allowed to keep. Anything over this amount will have to be spent down pursuant to Medicaid guidelines.
A person must be financially eligible to qualify for Nursing Home Medicaid.
We will work with the Nursing Home and County Office to procure a PAS evaluation. In essence, the PAS evaluation serves to determine whether or not the loved one needs the level of long-term care that the family seeks.
Gifts Given During Previous Five Years:
During this process, the family will have to explain any gifts (or uncompensated transfers) for the previous 60 months. Unless such transfers can be legally justified, this may postpone the approval of the application.
The caseworkers, in some counties, run afoul of the regulations by declaring various transfers UNACCEPTABLE when in essence, they are NOT! We will be there in the event this occurs.
Notice of Eligiblity or Rejection:
After the County Medicaid Office has had the opportunity to scrutinize the application and supporting materials, they issue a determination. If the Nursing Home application is approved, the family will be so adviced. If additional information is needed for the County to make a determination, that will be revealed as well.
If the application is rejected, the family has the option to supply any additional documentation or ask for an appeal. The appeals process is known as a "Fair Hearing."
Assets and Income Transferred to the At-Home Healthy Spouse:
When there is an at-home "healthy" spouse, Medicaid will allow certain assets or monthly income to be transferred to such person.