Recent Articles

Follow Us
  >  New Jersey Medicaid   >  Changes to New Jersey Medicaid Coming November 1

Changes to New Jersey Medicaid Coming November 1

                I have written for many years about Medicaid’s strict income limit or “cap”   Individuals over the cap can’t qualify for some Medicaid programs, such as assisted living or home based Medicaid.

                That’s because New Jersey is what is known as an income cap state with a Medically Needy program.  For those seeking Medicaid for nursing home care there is the Medicaid Only program.  The income cap is $2163 per month for 2014 and is adjusted every year for inflation.  The income we are concerned with is that which you receive as long as you live, no matter what.  Social Security and pensions typically fall into this category, but not interest and dividends from investments.  (That’s because assets must be at less than $2000 so interest is nonexistent.)

                If you are over the income cap by even $1 you can’t qualify for the Medicaid Only program.  That hasn’t been a problem for nursing home residents because the Medically Needy program covers them if their income is too high.  But, the Medically Needy program has never been available to residents in the community, such as those in an assisted living facility or receiving long term care at home.

                For many years we’ve had clients with income over the income cap who categorically can’t qualify for assisted living or home based Medicaid but who don’t have enough to pay privately either.   They have been forced into a nursing home because there hasn’t been any other option and that’s the only place where Medicaid will cover them.

                New changes to take effect November 1, however, will allow those individuals with income over the income cap to qualify for Medicaid in the community.  So, what happens to the excess income?  That’s where something known as a Miller trust comes into play.  We haven’t seen these trusts in New Jersey for 20 years or so but they are back.  It’s what is used in other states to address the excess income problem and in my next post I’ll explain how it works.