Seniors’ Eligibility for Medicaid in New Jersey

Navigating the world of Medicaid eligibility for seniors in New Jersey can be overwhelming, frustrating, and confusing. 

Medicaid is a public program that helps cover the cost of long-term care for seniors. This guide breaks down the various programs available and the requirements for applying in a straightforward and approachable way. Whether you are applying for yourself or helping a loved one in New Jersey, Senior Planning will help you make an informed decision so that you get the coverage you need. 

New Jersey Medicaid Eligibility Requirements

New Jersey Medicaid is available to seniors, people with disabilities, and low-income families who meet the state’s requirements. For seniors specifically, Medicaid can cover nursing home care, assisted living arrangements, or help at home. 

What are the eligibility requirements for Medicaid in New Jersey?

Eligibility for seniors is determined based on three main factors:

1. Age 65 or older

2. A U.S. citizen and permanent resident of New Jersey

3. Meet the New Jersey Medicaid eligibility income and asset limits

Medicaid New Jersey Income Limits 2025

The income limit for Medicaid eligibility in New Jersey is outlined in the table below. Please note that this is a quick reference and is subject to change.

Most sources of income are counted toward the Medicaid income limit, including:

• Employment wages

• Social Security benefits

• Alimony payments

• Pensions

• IRA withdrawals

In the case of married applicants, only the income of the applicant is considered in the Medicaid limit. Additionally, for the Nursing Home Medicaid program, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance. This ensures that the non-applicant spouse receives a monthly income from their applicant spouse, bringing their total income to $2,643.75. This does not apply to Regular Medicaid/Aged Blind and Disabled.

New Jersey Medicaid Asset Limits

In addition to Medicaid's income limit, there is an asset limit. Assets included in this limit are cash, stocks, bonds, IRAs/401Ks, additional real estate to one's primary home, investments, and bank accounts. 

For married applicants, all assets are considered jointly owned and are counted in the asset limits outlined in the table below. 

Medicaid Look-Back Rules in New Jersey

New Jersey Medicaid has a 5-year look-back period, which examines any asset transfers made within the 60 months preceding the application. Medicaid examines these transfers to ensure that nothing was gifted or sold at a price below fair market value in order to meet the set asset limit. However, there is no look-back rule for Regular Medicaid.  

How to Qualify for Medicaid if You Exceed the Limits

If the applicant exceeds the set Medicaid limits, there are still ways that they can qualify. 

1. Asset Spend Down: New Jersey Medicaid spend down rules allow using funds exceeding the asset limit on things that Medicaid doesn’t count. This can include home improvements like wheelchair ramps or stair lifts, paying off debts, or prepaying for burial costs. These should be properly recorded to ensure that it does not break Medicaid’s Look Back Rule. 

2. Medically Needy Pathway: New Jersey's Medically Needy program helps people who earn above the set income limit to still qualify for Medicaid. This includes spending excess income to cover medical expenses, such as doctors' bills or health insurance.

3. Qualified Income Trusts (QIT): A Qualified Income Trust (QIT), also known as a Miller Trust, helps individuals who earn above the Medicaid income limit to still qualify for services such as nursing home care or home-based support. To achieve this, any income exceeding the limit is placed in a special trust, which is managed by a trustee. The money in the trust can be used only for specific expenses, such as health insurance or medical bills not covered by Medicaid. 

How to Apply for Medicaid in New Jersey for Seniors

With all the intricate details, applying for New Jersey Medicaid can be a complicated and confusing process. This is where Senior Planning comes in. We aim to make this process as simple and stress-free as possible by guiding you through the application process. Some of these steps include:

 

1. Select the Right Medicaid Program for You: The process begins by identifying the program that best meets your needs. For seniors, possible programs include Nursing Home Medicaid or Regular Medicaid/Aged Blind and Disabled.

2. Check Eligibility Requirements: Review New Jersey’s Medicaid guidelines to ensure you qualify. 

3. Gather Required Documents: Prepare the required documents for Medicaid to verify your eligibility. Some of the documents needed include:

• Valid ID (driver’s license or government-issued ID)

• Social Security card

• Bank statements

• Proof of income and assets

• Health insurance cards

• Medical records

4. Complete the Application: Fill out the Medicaid application either online through NJFamilyCare or with a paper form.

Submit!: Send in your application along with all the required documents.

Medicaid for Nursing Homes in New Jersey

Medicaid nursing home eligibility in New Jersey will cover the cost of long-term care in a nursing home for eligible seniors, including room, meals, and medical services. 

It is important to note that not all nursing homes accept Medicaid, and some may limit the number of Medicaid beds, so checking availability with each facility is essential.  

Medicaid for Assisted Living in New Jersey

While Medicaid covers the cost of nursing homes, applicants can also apply for assistance at home or in a community setting. Receiving care outside of a nursing home can be less expensive and may be preferred by some individuals. There are several programs in New Jersey that provide assistance outside of nursing homes. 

New Jersey Medicaid Long-Term Care Eligibility Support

Need help navigating the New Jersey Medicaid application process for long-term care? Senior Planning assists seniors and their families, guiding you through every step of the journey to ensure you or your loved one gets the care they need. Contact Senior Planning today to get started.

Frequently Asked Questions about New Jersey Medicaid

What are the New Jersey nursing home Medicaid rules?

To qualify for nursing home Medicaid in New Jersey, a person must meet both the financial and medical requirements. 

• Financially, the individual must meet the income and asset limits. 

• Medically, they may need a nursing home level of care.

Does Medicaid pay for low-income seniors in NJ?

Yes, Medicaid in New Jersey provides coverage for low-income seniors. It can be used towards services such as nursing home care, assisted living, home health care, and other medical expenses.

What happens after I receive Medicaid eligibility in NJ?

Once approved for Medicaid, you will be enrolled in a managed care plan that coordinates your healthcare benefits. This will ensure that you receive help in arranging nursing home placements, home care, or other forms of support.