Medicaid is a health insurance program for needy individuals; however, unlike most health insurance programs, some programs of Medicaid will pay for long-term care costs, such as care in a nursing home. Medicaid is a cooperative program between the federal and state governments.
Each state must voluntarily chose to participate in the Medicaid program. Every one of the fifty states has voluntarily chosen to participate in the Medicaid program, including New Jersey. When a state participates in the Medicaid program, the federal government contributes 50% or more of the cost of the program.
There are various programs of Medicaid in New Jersey. The two main groups of Medicaid programs are community Medicaid programs and institutional Medicaid programs. A community Medicaid program provides a traditional health insurance policy for needy individuals. An institutional Medicaid program provides traditional health insurance and assists with the costs of long-term care services, such as nursing home care.
A state can also chose to expand its institutional Medicaid programs to pay for long-term care services at home or in an assisted living residence. When a state voluntarily chooses to expand its institutional Medicaid program to pay for care at home or in an assisted living residence, the state is said to have implemented a “waiver program.”
New Jersey has several waiver programs that provide care to needy individuals at home or in an assisted living residence. If an applicant for Medicaid benefits qualifies for a waiver program, he can receive long-term care services at home (such as a home health aide) or in an assisted living residence.
Currently, New Jersey’s waiver programs have an income cap on eligibility. What this means is, if an applicant who has applied for a waiver service has income that exceeds a certain level, he cannot qualify for waiver services, no matter what assets he owns.
Currently, the income cap in New Jersey is $2,163 per month in gross income. If an applicant’s gross income exceeds $2,163 per month, even by one penny, he will not qualify for waiver services even if he owns no assets at all and needs the services that the Medicaid waiver program provides.
In October 2012, the New Jersey Medicaid department received permission from the federal Medicaid department to expand New Jersey’s Medicaid program to cover those individuals whose income exceeds the $2,163 per month income cap. To date, the State has failed to implement the new program.
The state was going to implement the new program in January 2013, then in July 2013, then in January 2014, then in July 2014. At a recent meeting with the individual in charge of implementing New Jersey’s new Medicaid program, I learned that a July 2014 implementation date probably will not happen.
New Jersey is expanding its Medicaid program to cover individuals whose income exceeds the income cap because a decision of the United States Supreme Court known as the Olmstead decision and because the Americans with Disabilities Act compel the various states to provide care to disabled individuals in settings that are the least restrictive. In other words, if a disabled (or elderly) individual could be living at home instead of in a nursing home, then the Medicaid program should assist him with living at home, not forcing him to live in a nursing home.
New Jersey’s new Medicaid waiver program has some admirable ambitions. New Jersey’s failure to implement this program nearly eighteen months after they received approval of the program from the federal government is far less admirable.