Caring for Our Families & Residents
Medicaid
What is the Medicaid Program? Medicaid is the state and federally-funded health assistance program for certain groups of adults and children with low-to-moderate incomes and resources. Medicaid benefits are provided to most eligible persons through Health Maintenance Organizations. Medicaid also covers individuals who reside in nursing homes and assisted living facilities.
- Prescriptions and Durable Medical Equipment
- Note: Depending upon the Medicaid program you are enrolled in, not all of the listed Medicaid services may be available.
- Physician Services
- Dental and Optometry Services
- Laboratory and X-Ray Services
- Hospital Services
- Medical Transportation
- Hearing Aids
What medical assistance programs are available?
BREAST AND CERVICAL CANCER PROGRAM: provides Medicaid Benefits to uninsured individuals under the age of 65 who have been diagnosed with breast or cervical cancer and are in need of treatment. Individuals must be screened through the New Jersey Cancer Education and Early Detection Screening Program (NJCEED) administered by the New Jersey Department of Health and Senior Services. For more information on where individuals can get free screening services, call 1-800-328-3838.
MEDICALLY NEEDY: offers limited Medicaid coverage to individuals in a community setting who are blind, disabled, or 65 or older and have income or assets too high to qualify for coverage under NJ Family Care. The Medically Needy program was closed to new long-term care applicants as of December 1, 2014. Individuals who receive coverage through the Medically Needy program do not receive HMO, prescription, or inpatient hospitalization coverage.
MEPPA (MEDICAL EMERGENCY PAYMENT PROGRAM FOR ALIENS): may cover medical bills related to treating an emergency medical condition and is only for NJ residents who meet other Medicaid eligibility requirements except for their US citizenship/legal status. Undocumented immigrants or immigrants who do not have legal permanent resident status for 5 years may apply if they have had a recent medical emergency. An application must be made within 3 months of the date of the emergency to be considered for coverage under this program.
MLTSS (MANAGED LONG-TERM SERVICES AND SUPPORTS): refers to delivering long-term care services and support through New Jersey Medicaid’s NJ Family Care managed care program. Under MLTSS, an individual’s HMO will coordinate all healthcare services, whether the individual is at home, in an assisted living facility, a residential facility, or a nursing home. The consolidation of Medicaid programs under the name NJ Family Care also includes the programs that have historically covered the aged, blind, and disabled populations who require long-term care. MLTSS is the program that now encompasses programs formerly known as ACCAP (Aids Community Care Alternative Program), CRPD (Community Resources for Persons with Disabilities), GO (Global Options), Hospice, and TBI (Traumatic Brain Injury).
PACE (Program of All-Inclusive Care for the Elderly): is another MLTSS program that provides customized care to individuals aged 55 and older who live in the service area and meet the nursing facility level of care established by Medicaid. Services include but are not limited to primary care, hospital care, prescription drugs, home care, medical transportation, physical therapy, adult day care, assisted living, and nursing home care. Individuals receive a customized care plan that is delivered by a coordinated interdisciplinary team.
NJ FAMILYCARE: provides health coverage to children, pregnant women, parents/caretaker relatives, single adults, childless couples, the aged, blind, disabled, and individuals qualified for long-term care services. NJ Family Care’s comprehensive health coverage program provides a wide range of services depending on the person’s eligibility category. Most NJ Family Care beneficiaries (except MEPPA) have their health care coordinated by an HMO of their choosing.
NJ WORKABILITY: is a program under NJ Family Care that provides coverage to disabled individuals under the age of 65 who are employed.
QUALIFIED MEDICARE BENEFICIARY (QMB) PROGRAM: provides eligible Medicare recipients with payment of their Medicare Part B medical insurance premium and deductibles. Coverage for QMB is included in most NJ Family Care programs and does not require a separate application.
Applications for Medicaid coverage will also be accepted by mail, fax, and in some cases, online. If you have any questions regarding the redetermination process, call 973-881-0100 and one of our staff members can assist you.
NJ FamilyCare
What is NJ FamilyCare?
It is a federal and state-funded health insurance program created to help qualified New Jersey residents of any age access affordable health insurance. NJ FamilyCare is for people who do not have employer insurance.
This services offers the benefits of free or low-cost healthcare coverage and peace of mind knowing that you don’t have to worry about unexpected healthcare bills. For higher-income families with children, there is a sliding scale for copayments.
Medicaid for the Aged/Blind/Disabled
Medicaid ABD provides health insurance to low-income individuals who reside in the community and who are aged 65 and over, blind, or disabled. Eligibility for the program depends on several factors, including income, household size, resources, etc.
Applicant must meet the following minimum criteria:
- Adults must be a legal permanent resident for no less than 5 years – this requirement does not apply in certain cases.
- Family’s income must be under the income limit.
- Resources such as savings, checking accounts, bonds, and immediate disposable assets must be below a standard resource limit (as the limit depends on the program/HH size).
Even if you do not meet the criteria above, you or your representative should consult with a caseworker or call 1-800-701-0710 to discuss your current situation and determine if you can become eligible for this program.
