NEW JERSEY

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICE

The New Jersey Division of Medical Assistance and Health Services under the New Jersey Department of Human Services is the state agency responsible for administering the Medical Assistance programs created by the Federal and State governments to assist people with low incomes.  These programs are commonly grouped under the Medicaid benefits label.  

Indicated below are the links to the Administrative Code developed by the Department of Human Services describing the very detailed Administrative rules and procedures governing the various Medicaid programs in the state and a more general summary overview of the programs administered by the New Jersey Division of Medical Assistance and Health Services.  This summary analysis includes the following: a description of the covered services, the eligibility criteria to participate in these programs, required application documentation and the phone numbers of the County Board of Social Services to apply for these programs. 

This information is to assist people in understanding the Medicaid programs available in the state of New Jersey.  It is for information purposes only and Disability Services & Advocacy, LLC accepts not liability for any errors contained herein.  

A. ADMINISTRATIVE CODE GOVERNING NEW JERSEY'S MEDICAID PROGRAMS

B. OVERVIEW OF MEDICAID PROGRAMS

I.   MEDICAL ASSISTANCE PROGRAMS
II.  COVERED SERVICES
III.  FINANCIAL ELIGIBILITY CRITERIA
IV. DOCUMENTS NEEDED FOR APPLICATION INTERVIEW
V.  COUNTY PHONE NUMBERS TO APPLY FOR MEDICAID

I. MEDICAL ASSISTANCE PROGRAMS

A. MEDICAID LONG TERM CARE (NURSING HOME SERVICES) 
B. MEDICAID COMMUNITY CARE
C. NEW JERSEY CARES - LONG TERM CARE (NURS. HM SVS.)
D. NEW JERSEY CARES - COMMUNITY CARE
E. MEDICALLY NEEDY - LONG TERM CARE (NURS. HM. SVS.)
F. MEDICALLY NEEDY - COMMUNITY CARE
G. RESIDENTIAL HEALTH CARE
H. CCPED (Community Care Program for Elderly & Disabled)
I. MODEL WAIVER I, II, III,
J. A C C A P (AIDS)
K. TBI (Traumatic Brain Injury)
L. HOSPICE

A. MEDICAID LONG TERM CARE

    1. Eligibility Critera -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    * Medical Assessment Required

    2. Financial Eligibility -

    Income - $1,536.00 / Month
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

B. MEDICAID COMMUNITY CARE

    1. Eligibility Criteria -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $543.25 Monthly or $385.65 Monthly 
    (Depending on living arrangements)
    Resources - $2,000
   

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

C. NEW JERSEY CARES ABD - LONG TERM CARE

   1. Eligibility Criteria -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $696 Monthly
    Resources - $4,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

D. NEW JERSEY CARES ABD - COMMUNITY

   1. Eligibility Criteria -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $696 Monthly
    Resources - $4,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

E. MEDICALLY NEEDY ABD - LONG TERM CARE

    1. Eligibility -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    (If income exceeds the medicaid cap ($1,536) it may be reduced 
    by medical expenses.)

    3. Covered Services -

    Limited Medicaid Coverage

    4. Slots -

    N/A

F. MEDICALLY NEEDY ABD - COMMUNITY

    1. Eligibility -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    (If income exceeds the medicaid cap ($1,536) it may be
    reduced by medical expenses.)

    3. Covered Services -

    Limited Medicaid Coverage

    4. Slots -

    N/A

G. RESIDENTIAL HEALTH CARE

    1. Eligibility Criteria -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $662.05 Monthly
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

H. CCPED (Community Care Program for Elderly & Disabled)

    1. Eligibility -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $1536.00 Monthly 
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Limited
    Prescription drugs effective 10/1/99

    4. Slots -

    2350 per state

I. MODEL WAIVER I, II, III

    1. Eligibility -

    Aged - 65 years
    Blind - SS Disability or BMA approved
    Disabled - SS Disability or BMA approved

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage Plus
    Case Management, model waiver III skilled nursing

    4. Slots -

    I-50
    II-50
    III-50

J. A.C.C.A.P. (AIDS)

    1. Eligibility -

    Diagnosis of AIDS or
    Medical Assessment Required

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage Plus
    Up to 16 Hrs. a day skilled nursing care

    4. Slots -

    31

K. TBI (Traumatic Brain Injury)

    1. Eligibility -

    Diagnosis of acquired brain injury, rating of at least 4 on the
    rancho los amigo scale.

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Full Medicaid Coverage

    4. Slots -

    N/A

L. HOSPICE

    1. Eligibility -

    Be certified terminally ill by attending physician and
    voluntarily elect hospice services via a medicaid hospice
    provider.

    2. Financial Eligibility -

    Income - $1536.00 Monthly
    Resources - $2,000
    $1,500 Life Insurance or prepaid burial-vault and casket excluded

    3. Covered Services -

    Hospice and physician services if pre-approved by hospice.

    4. Slots -

    N/A

II. COVERED SERVICES

A. FULL MEDICAID
B. CCPED/WAIVER PROGRAMS
C. MEDICALLY NEEDY ABD & LONG TERM CARE

A. FULL MEDICAID SERVICES

    *You may obtain rehabilitation services (such as physical
     therapy, occupational therapy and speech therapy) through an
     independent clinic or home health agency and audiology
     through an independent clinic. 

MEDICALLY NEEDY LONG TERM CARE SERVICES

Includes all the services indicated above under Medically Needy ABD, in addition to, pharmaceuticals.

III. FINANCIAL ELIGIBILITY CRITERIA

A.  COUNTABLE INCOME
B.  COUNTABLE RESOURCES

A. INCOME COUNTED IN DETERMINING FINANCIAL ELIGIBILITY

B. RESOURCES COUNTED IN DETERMINING FINANCIAL ELIGIBILITY

IV. DOCUMENTS NEEDED FOR APPLICATION INTERVIEW

BRING ONE SET OF ORIGINALS AND PHOTOCOPIES AT THE TIME OF THE INTERVIEW FOR MEDICAID BENEFITS

APPLICANTS FOR NON-INSTITUTION PROGRAMS WILL NEED THESE ADDITIONAL DOCUMENTS

V. PHONE NUMBERS FOR THE COUNTY BOARD OF SOCIAL SERVICES TO APPLY FOR MEDICAID