This webpage focuses on the resources available to seniors with low income who wish to remain in their home. Several Medicaid-based programs are available to help pay for medical related expenses.
New Jersey Care: New Jersey care offers full Medicaid benefits to NJ residents age 65 or older or who are blind or permanently disabled under the Social Security Administration definition. If eligible, New Jersey Care will cover your Medicare Part B premium, as well as your Part A premium if you are required to pay one.
The income and asset limits for New Jersey Care are $749/mo. if single, with resources at or below $4,000. For married couples, the income limit is $1,010/mo. with $6,000 or less in resources. (2004 figures)
Specified Low Income Medicare Beneficiary: SLMB pays the Medicare Part B premium only and has slightly higher income guidelines than the New Jersey Care program.
Medically Needy Program: The Medically Needy program assists individuals that do not qualify for Medicaid to receive health care services. The benefits available are very similar to those offered by Medicaid. The program is mainly designed to help those with excessive medical bills.
Community Choice: This program was created to help nursing home residents and hospital patients explore their options for long-term care in the community. Information is available regarding in-home services, housing options and community programs. Community Choice Counselors work with the social worker, discharge planner, nursing staff, therapists and family members to find the long-term care plan that will most effectively meet the needs of the individual.
Once a discharge plan has been decided and executed, the Counselors follow up with the individual 24-48 hours after discharge and again 2-4 weeks later to ensure that all is going well with the placement in the community. If problems have arisen, the counselor may suggest solutions or make a home visit to assess the situation. Income does not affect eligibility for this program.
CCPED: The Community Care Program for the Elderly and Disabled (CCPED) began to help elderly and disabled individuals remain in the community or return to the community if institutionalized. Services available under CCPED include case management, home healthcare or homemaker, medical or social day care, non-emergency medical transportation, respite care and prescription drugs.
There are both age and health coverage requirements for CCPED eligibility. Monthly income must not exceed $1,737 and resources are limited to $2,000 or less for individuals. Couples may have $3,000 per month in income and $4,000 in assets. All individuals must also be assessed by the Department of Health and Senior Services as in need of nursing facility level of care. A maximum of 40 hours per week may be available to the recipient.
Enhanced Community Options: ECO is a Medicaid Waiver that offers a variety of alternatives to those faced with nursing home placement. The program is available to those individuals determined to require nursing facility level of care but prefer to remain in a community setting.
The residential component to ECO is the Assisted Living and Alternate Family Care (AL/AFC). Assisted Living may provide assistance in personal care, medication management and everyday activities in an Assisted Living Residence (ALR), Comprehensive Personal Care Home (CPHC), or an Assisted Living Program (ALP). Alternate Family Care service is provided under a contractual agreement where the individual resides in the home of an unrelated person who has been trained and approved to provide caregiving. Questions regarding AL/AFC can be directed to (609) 584-4980.
The in-home component to ECO is the Caregiver Assistance Program (CAP), which is designed to supplement the assistance an individual receives from family, friends, volunteers and other service agencies. The program can provide medical equipment and alterations to make a home wheelchair accessible, such as adding ramps or updating bathrooms. Questions regarding CAP can be directed to (609) 588-7361.
To meet the financial aspect of eligibility for the AL/AFC and CAP programs, individuals must either 1) qualify for SSI in the community; 2) qualify for Medicaid only (income at or below $1,737 per month & resources at or below $2,000); or 3) qualify for New Jersey Care (income at or below 100% of Federal Poverty Level- $749/mo. for individuals & resources at or below $4,000; $1,010 for couples & resources at or below $6,000).
JACC: Jersey Assistance for Community Caregivers (JACC) provides in-home support services to help individuals remain in their home. The program is intended to supplement and strengthen the capacity of caregivers by developing a Plan of Care specific to the individual’s needs. For JACC eligibility, individuals must have $40,000 or less in countable resources; couples must have $60,000 or less. Income limits do apply, but the income that is counted is not the gross income. Income calculations are made by deducting qualifying medical expenses and health insurance premiums from the gross income. The remaining income is viewed by the program as your income. The limit for individuals is $30,395 per year and $41,064 per year for couples. Other eligibility requirements do apply, and JACC services are limited to $600 per month and $7,200 per year per person.
Medical Day Care: Medical day care was developed to provide medically supervised health-related services to individuals that are not residents of health-care facilities but are in need of some health services. Participants generally have a chronic illness or are disabled. Individuals who wish to attend medical day care services must meet certain financial and medical requirements in order for Medicaid to reimburse the program. Private pay is also available to those who do not meet Medicaid requirements.
Social Day Care: Social adult day care (SADC) programs emphasize social and recreational group activities and offer some health monitoring. Such programs are available under CCPED and the ECO waiver.
AIDS Community Care Alternatives Program: The ACCAP is designed to provide case management, private duty nursing, hospice and specialized group services in addition to regular Medicaid services to individuals with AIDS. To qualify for the benefits, individuals must be in need of an institutional level of care, financially eligible and wish to remain in the community. Those under the age of 65 must also have a disability determination from the Social Security Administration.
Respite Care Program: New Jersey offers a respite care program to families and uncompensated caregivers who are experiencing fatigue and stress as a result of providing long-term care to the frail elderly or functionally impaired individuals 18 or older. The temporary, short-term and intermittent care can be provided to give relief from both physical and emotional demands involved in caregiving. It can allow caregivers time to shop, rest, vacation and attend to personal or emergency matters.
Medical Assistance / Doctor Referral: Generally, your local hospital can provide referrals to physicians that cater to a specific medical need. Atlantic Health System’s Doctor Finder/Physician Referral can be reached at 1-800-247-9580.
The Medical Society of Morris County also offers a Courtesy Program designed to provide access to medical services for those who might otherwise forego medical treatment due to financial reasons. To participate in the Medical Courtesy Program you must at least meed the following eligibility requirements:
• Resident of Morris County;
• At least 65 years old;
• Enrolled in Medicare Part B; and
• Have a current PAAD Card
Additional income and asset requirements do apply so contact the Medical Society for further information and details at (973) 539-8888.
Hospice: Hospice is designed to provide care to individuals in the final months of their lives. Goals of hospice include the comfort and privacy of the patient, as well as pain management and emotional support in their own homes. Care is available 24 hours a day, 365 days a year. Many private medical insurance programs cover the cost of hospice services, as do Medicare and Medicaid. For more information, contact Hospice of Morris County at (973) 539-6121 or The Center for Hospice Care at (973) 429-0300.
Long Term Care Insurance: Insurance may be purchased to help offset the costs associated with long term care at home or in a residential nursing facility. This type of insurance is relatively new and probably is not for those with a single source of income, such as Social Security or SSI. Some factors affecting whether you should purchase a long-term care policy include your age, health status, overall retirement goals, income and assets. Some federal income tax advantages are available to those who buy certain long-term care insurance policies.
Additional information on all of the programs mentioned in this Newsletter may be obtained by calling the NJ EASE hotline at 1-877-222-3737. Information is also available through the NJ Office of Long Term Care Options at 1-877-856-0877.
For information regarding these subjects you may contact the office of Michael Bolton, Esq. at (973) 425-0497.
