ASSISTED LIVING RESIDENCE WAITING LIST
The flaw inherent in New Jersey’s Medicaid program that will help pay for an assisted living residence has become apparent. Although New Jersey does have a Medicaid program that will help an eligible individual pay for the cost of a room in an assisted living residence, known as Assisted Living/Alternate Family Care (“AL/AFC”), the program is only open to 1,500 people.
In case you haven’t noticed when you’re driving in your car, New Jersey is a very populated state. And, what makes the situation even worse, a very high percentage of New Jersey’s population is elderly individuals. In fact, New Jersey has the second highest population of persons over the age of sixty-five in the nation, second only to Florida.
New Jersey has two programs of Medicaid. One of those programs is an “income cap” program. The other is a “medically needy” program. In order to qualify for the income cap program, a person can have no more than $1,635 a month in income. Persons who have more than $1,635 a month can qualify for the medically needy program, in most instances, and the medically needy program will pay for care in a nursing home.
But the medically needy program will not pay for care in an assisted living residence (“ALR”). Only individuals who meet the income cap requirement are eligible to qualify for the AL/AFC program. What this means is, someone with $1,700 a month in income would never qualify for AL/AFC, but someone with $1,600 a month would. Both are incapable of paying for an ALR, which costs, on average, between $2,700 to $5,000 a month, but the former must forego services or go to a nursing home while the latter could enter an ALR.
That’s unfair enough. But now the State’s reluctance to extend the AL/AFC program is affecting even those persons who can meet the financial criteria to qualify for the program. With only 1,500 slots statewide, the available slots for the AL/AFC program have filled-up. There’s no more room at the inn.
The State has implemented a new procedure for filling vacancies that occur in the AL/AFC program. That procedure gives priority to those individuals who are in an ALR that has a vacant Medicaid bed and is willing to accept the resident as a Medicaid patient. So, if a slot on the AL/AFC program becomes available, persons who are already in an ALR that will accept them on Medicaid and who qualify for Medicaid will receive priority, based upon length of time on the waiting list.
This policy may seem plausible, but from a practical standpoint, a stay on the waiting list could prove very difficult. For instance, assume that you are Medicaid eligible – you must be Medicaid eligible to even be on the waiting list. You have less than $2,000. You also have less than $1,635 a month in income. You’re in an ALR that costs $3,500 a month. How do you pay for your care if you are told that the waiting list is estimated to be six months long?
Will the ALR be gracious enough to accept $1,635 as payment in full for the next six months? What if your wait is a year or more? Will the ALR continue to be gracious?
People reside in an ALR because they aren’t in the best of health. How would you like to be sickly and constantly have to worry that someone is going to throw you out on the street, or place you in a nursing home?
And, if you go to a nursing home, you’re no longer a resident at an ALR that is willing to accept you as a Medicaid patient, so you lose your priority on the AL/AFC waiting list. It’s a vicious circle that you may never escape.
New Jersey needs to expand the coverage options under its community Medicaid programs, such as the AL/AFC program. State-sponsored long-term care options are essential to our State. That fact never becomes more apparent than when you or someone in your family needs long-term care.
Medicaid can be a big help, but waiting lists are a reality for many seniors. Planning ahead and exploring all options can make the process smoother and give families peace of mind while waiting for care to become available.