The New Jersey

Medicaid

application

process is complex,

but help

is available.

New Jersey Medicaid rules are arguably the most difficult to navigate in the country.  The rules are based partly in written law, partly in case law, and partly in written policy.  To further complicate matters, all of the above are subject to the whims of the 21 Medicaid County offices.
The Medicaid Application process requires great detail and organization, from gathering five years of bank statements, proof of documentation and life insurance, to meeting with the County Medicaid Agency and navigating a maze of rules and regulations.  One mistake in eligibility can cost you months of nursing home care.

New Jersey Medicaid Application Process

The bottom line is that the application process is complex.

An experienced NJ Medicaid Lawyer like those at Begley Law Group 
can help facilitate and expedite the Medicaid application process.
Although practice differs slightly from county to county, the basic format is relatively the same. A request for nursing home Medicaid is filed with the County Board of Social Services where the loved one is receiving his or her long-term care.  Some counties may have more than one office located in their jurisdiction. 
 
The county Medicaid office summons the loved ones agent to attend an intake conference. Unlike other states, New Jersey 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. Also hope you gather the supporting materials and documentation. We will attend the intake conference with you and systematically presented the caseworker with everything that is required.
 
Married couples with an at-home healthy spouse call 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.

Initial steps:

Financial eligibility:

Medical eligibility:

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 loved one needs the level of long-term care that this the family seeks.

Gifts given during the previous five years:

During this process, the family will have to explained any gifts premises or uncompensated transfers parentheses 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!  It is important to have representation with you in the event this occurs.

Notice of Eligibility 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 advised.  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 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.

Special Programs:

Within NJ Medicaid there are also a number of special programs designed to meet the specific medical needs of certain groups of people who would not otherwise qualify for the program.

These include:

  • Medical Emergency Payment Program for Aliens
  •  Home and Community-based Services Waiver Programs (described below)
  • NJCEED – New Jersey Cancer Education and Early Detection Program
  • The Division of Aging Services in the Department of Human Services administers a number of home and community-based programs for seniors
  • The Division of Disability Services in the Department of Human Services administers home and community-based services for people with disabilities

For questions about New Jersey Medicaid, call 1-800-356-1561 or your County Welfare Agency.

For help with your New Jersey Medicaid application, visit the experienced New Jersey Medicaid and Elder Law attorneys at Begley Law Group.