Managed Long-Term Services and Supports (MLTSS) refers to the delivery of long-term services and support through New Jersey Medicaid ‘s NJ Family Care managed care program. MLTSS is designed to expand home and community-based service, promote community inclusion and ensure quality and efficiency. MLTSS uses NJ Family Care manages care organization (also known as HMOs or Health Plans) to coordinate ALL services. Currently, NJ Family Care members have their acute and primary health care services and their home and community-based services coordinated by different supports, whether at home in an assisted living facility, in community residential services, or in a nursing home. For more information you can contact the State www.state.nj.us/humanservices/dmahs/home/mltss.html
The types of services MLTSS offers include:
· Personal care
· Respite care
· Care management
· Home and vehicle modifications
· Home delivered meals
· Personal emergency response systems
· Mental health and addiction services
· Assisted living
· Community residential services
· Nursing home care
MLTSS are additional services and supports for people who are determined clinically eligible. Clinical eligibility means that they require assistance with three or more activities of daily living, such as mobility assistance, dressing, bathing, eating and other self-care. These individuals may need nursing home placement or choose to live in their community, such as an assisted living type setting or in their home. MLTSS can help people remain in their homes and communities by providing extra services such as, but not limited to, personal care, home-delivered meals, and care management.
To qualify for MLTSS, an applicant must be both clinically and financially eligible. The local County Welfare Agency will do the financial evaluation using information provided in the Aged, Blind, Disabled Application while the Division of Aging Services is responsible for the clinical eligibility determination for MLTSS. The two evaluations are completed concurrently and are coordinated between both agencies. An individual determined clinically eligible by the Division of Aging Services qualifies at a higher income limit of $2,523 per month for a single person with a resource maximum of $2,000 in 2022. In determining financial eligibility, if the gross monthly income exceeds the income limit allowed, he or she can establish and fund a Qualified Income Trust (QIT) with the excess income that is above the limit. More information about a QIT is found on Page 9 under Qualified Income Trust.
The financial eligibility process also includes a five-year look- back of the applicant’s financial accounts and resources to determine if there have been any assets transferred for less than fair market value. To be eligible, a person applying for LTSS must disclose all income and all resources from the past 5 years.
Applicants’ Income, Resources and Documentation
The NJ Family Care Eligibility Determining Agency (EDA) verifies your information. If the EDA cannot electronically verify your personal information, you may be asked to provide proof of identity, age, citizenship and/or marital status. The EDA may also ask for documentation that will prove what you own, how much income you receive, where this income comes from, and how much you spend on living expenses.
During the eligibility determination process, the information you provided will be verified. If there is missing information, you will receive a letter. Failure to respond timely to these letters will cause your application to be denied.
Include all relevant information along with your application
Income You Receive
Income can come from different sources such as a paycheck, pension, or interest from an investment account.
Listed below are examples that can prove your income.
• Income Statement from Employer/Pay Stubs
• Pension Information
• Unemployment Benefit Statement
• Child Support Order
• Self-Employment Tax Return
• VA Explanation of Benefits
• Interest
• Proof of Rental/Royalty Income
• Social Security Award Letter
• Retirement Account Statement
• Dividends
• Income from Trust Funds
• Annuity Payments
• Workman’s Compensation/ Disability
• SSI Payments
Applicants’ Income, Resources and Documentation
What You Own
Ownership is not limited to homes and automobiles - it can include cash values of life insurance policies or annuities, trust funds, and many other things. Provide documentation with your application of any of the following items that you own or owned during the past five years:
• Cash on Hand
• Bank Accounts
• Deeds to all Property Owned
• Certificates of Deposit (CDs)
• Promissory Notes
• Annuities
• Mortgages
• Equipment/Inventory
• Automobile/Registrations
• Other Vehicles (Boat, Trailer, etc.)
• Holiday/Vacation Club Accounts
• Property Tax Statements
• All Life Insurance Policies
• All Trusts or other Holding Instruments
• Special Needs Trusts
• ABLE Accounts
• Retirement Accounts (403B)
• Individual Retirement Accounts (IRAs)
• Business/Real Estate Partnership Papers
• Burial Accounts/ Funeral Trusts
• Credit Union accounts
• Stocks or Bonds
• Deed to Burial Plots
• Land/Mineral Rights
• Keogh Accounts (401K)
• Contracts
• Mobile Home
Your Other Documents
• Copy of health insurance card(s) – front and back
• Designated Authorized Representative Form
• Copy of any settlements
• Power of Attorney
• Guardianship
• Third Party Signatory
• Court Pleadings
Applicants in need of Managed Long-Term Services and Supports (MLTSS) may also be required to submit the following information:
Your Living Expenses
How much money do you (and your spouse) need to live in the community each month? The expense of maintaining your house or renting an apartment can account for a large part of your monthly income. The following are examples of expenses to include with your application:
• Rent Payments
• Telephone Bills
• Water / Sewer Bills
• Health Insurance Bills
• Mortgage Statements
• Gas /Oil Bills
• Real Estate Tax Bills
• Electric Bills
• Renter / Homeowner Insurance
Five-Year Lookback on Resources
The five-year lookback on all resources is done according to federal regulations. The lookback period checks for any resources that may have been transferred for less than fair market value during the previous five years.
Examples of accounts and transactions include:
• Checking Accounts
• Money Market Accounts
• Savings Accounts
• Any Transfers/Sales (money or real estate)
• Credit Union Shares/Accounts
• Investment Accounts
• Life Insurance Policies
The EDA will verify electronically whenever possible. If the EDA requires more information, you may be asked to provide quarterly statements (or all statements) from the past 5 years, and additional information related to these funds or any other resource.
Qualified Income Trust (QIT)
Qualified Income Trust (QIT), also known as a Miller Trust, is a special legal arrangement for holding a person’s income. Individuals with monthly income above the Medicaid Only institutional income limit ($2,523 per month in 2022) must establish a QIT if they meet an institutional level of care and are trying to obtain Medicaid eligibility for Long Term Services and Supports. A QIT is a written trust agreement for which the trustee establishes a dedicated bank account. The income deposited into this dedicated bank account is disregarded when determining financial eligibility for Long Term Services and Supports. QITs require that a trustee is appointed to manage the monthly deposits and expenses and account for the funds in the trust. A trustee must be someone other than the Medicaid applicant/recipient. QIT written agreements have special conditions that must be met and are subject to the approval of, and monitoring by, the appropriate Medicaid eligibility determining agency (EDA) and the Division of Medical Assistance and Health Services (DMAHS).
When applicable, provide the EDA with the ABD application along with the following documents in order to have the application processed:
• Qualified Income Trust Document
A simple, easy-to-follow template and more information for establishing this Trust may be found at: http://www.state.nj.us/humanservices/dmahs/clients/mtrusts.html
• Proof of funding the QIT is required for the month eligibility starts. This may be a deposit slip or bank statement showing the income is being deposited monthly.
• An individual’s own Social Security income or pension income can be deposited into the QIT in the month that it is received. An individual can direct all or some of their income to the QIT but all of the income from any one source (e.g. the entire monthly amount of a pension check) must be deposited into the QIT
The Medicaid Card
Once an individual is eligible for Medicaid, they will receive a Medicaid card, which entitles the individual to coverage. When the person goes to the doctor, or gets a prescription filled, they will be asked to show the Medicaid card. The health care provider files a claim with Medicaid. The individual cannot file the claim.
In some cases, there is a co-payment required for the services received.
Not all doctors and health care providers accept Medicaid. It is important to find out before services are received if the provider has agreed to accept Medicaid payment. If they do not, the individual will be responsible for paying the bill. If a provider participates in the Medicaid program, they have agreed to accept Medicaid payments as full payment, and the provider cannot charge the beneficiary the difference between what Medicaid pays and what they charge.
Not all medical services are covered under Medicaid, and the individual will be responsible for paying for those services not covered.
Covered Services Medicaid will pay for health care services that are covered and that are medically necessary. Some services are limited to a certain number per fiscal year (July 1 through June 30).
These services are subject to change and may be limited by who can receive them. The types of procedures that are covered, and the number of times they can be received and paid for by Medicaid may be found at www.state.nj.us.
Rights
Medicaid cannot discriminate based on race, color, national origin, or disability.
If an individual is turned down for eligibility, they have the right to appeal, and can request a fair hearing. This request must be made within 30 days of receiving notice of having been turned down. For More Information go to www.state.nj.us