Changes Made in Eligibility for New Jersey Global Options for Long Term Care
Moorestown, NJ (Law Firm Newswire) May 10, 2012 - On Jan. 1, 2009, the Centers for Medicare and Medicaid Services (CMS) gave the New Jersey Department of Health and Senior Services (DHSS) approval to consolidate three Medicaid Waiver programs: Assisted Living/Adult Family Care, also known as AL/AFC, Caregiver Assistance Program, or CAP, and the Community Care Program for the Elderly and Disabled (CCPED) into one program called Global Options for Long Term Care (GO).
Elder care attorney Susan M. Green of the Begley Law Group in Moorestown, N.J., said that the change was an improvement.
“Since this consolidation, at least 20 percent more participants have been served,” Green said. “Further, the average annual cost of GO is roughly two-thirds less than a nursing facility.”
GO is for individuals who are eligible for a nursing facility level of care, but who wish to remain in their homes. To meet the nursing facility level of care, individuals who do not have any defects in cognition must need assistance on a limited basis with at least three daily living activities, and individuals who do have cognitive deficits must need supervision with at least three daily living activities. GO enrollees must also meet income and asset requirements.
Additionally, GO participants agree to allow the county and the state to enter the participant’s home in order to monitor the services provided. This program is intended as a supplement to, not a replacement for, the assistance already being provided by family members and other loved ones, neighbors and friends.
Care managers work with GO participants to create individualized plans of care based on the participant’s health care needs. Care managers do not provide direct services, such as transportation, medical care, social work and therapeutic counseling.
GO was established as a participant-directed care program. With the help of the care manager, the participant is able to determine what services he or she needs, select providers of these services, and then ensure that the services are provided.
To be eligible for GO, an individual must meet all of the following criteria:
1. Resident of New Jersey
2. 65 years of age or older, or age 21-64 and physically disabled (as determined by the Social Security Administration or the Disability Review Section of the Division of Medical Assistance and Health Services)
3. Qualify for Medicaid financial eligibility
a. Qualify for SSI in the community, or
b. Qualify for Medicaid Only – Institutional Only, or
c. Qualify for New Jersey Care
c.i. Income at or below 100% of the poverty level as determined by the federal government, i.e. $11,170/year for a family of 1 or $15,130/year for a family of 2, and
c.ii. Resources at or below $4,000
4. Clinically eligible for a nursing facility level of care
5. Reside in an approved community living arrangement
Individuals who are under 21 or who are between 21 and 64, but who have a chronic mental illness, intellectual disability, or developmental disability are ineligible for GO.
Begley Law Group, P.C.
509 S. Lenola Road, Building 7
Moorestown, NJ 08057
View Larger Map
- RESOLVING VICTIMS OF CRIME COMPENSATION, STATE WORKERS’ COMPENSATION CLAIMS, AND FEDERAL EMPLOYEE COMPENSATION ACT LIENS IN PERSONAL INJURY CASES
by Thomas D. Begley, Jr., CELA Victims of Crime Compensation In New Jersey, certain victims of crime are entitled to compensation under the Criminal Injuries Compensation Act of 1971. The Act covers individuals injured or killed by any act or omission of any other person, which is within the description of offenses listed within the Act. The state has a right of subrogation against the person responsible for personal injury or death, and a lien after entry of judgment. State Workers’ Compensation Claims When there is a state Workers’ Compensation (WC) claim and also a third party liability case, [...]
- RESOLVING MEDICARE ADVANTAGE, PRESCRIPTION DRUG PLAN, VETERANS ADMINISTRATION, TRICARE AND WELFARE LIENS IN PERSONAL INJURY CASES
by Thomas D. Begley, Jr., CELA Medicare Advantage and Prescription Drug Plans Medicare Part C, commonly known as Medicare Advantage, is a Medicare substitute program operated by private health insurance companies as a managed care plan. Medicare Part D similarly provides prescription coverage to eligible beneficiaries through private insurance plans. To the extent a reimbursement right may be created under a specific MAO plan, the Part C statute itself limits any recovery from a beneficiary to the amount actually received from a third party as payment for plan-covered expenses. Veterans Administration and TRICARE Claims The Veterans’ Benefits Act and the [...]
- RESOLVING MENTAL HEALTH LIENS, TRAUMATIC BRAIN INJURY FUND LIENS, CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND LIENS IN PERSONAL INJURY CASES
by Thomas D. Begley, Jr., CELA Mental Health Liens In New Jersey, a person with a mental illness who is over age 18 and is being treated in a state psychiatric hospital shall be liable for the full cost of his treatment, maintenance, and all necessary related expenses. Although this statute does include a repayment obligation, it does not appear to impose a lien, particularly with respect to personal injury claims. Traumatic Brain Injury Fund The New Jersey Traumatic Brain Injury Fund is the payer of last resort for costs of post-acute care, services, and financial assistance provided to [...]
See other news sources publishing this article. BETA | Tags: new jersey elder law, new jersey elder law attorney, new jersey estate planning, new jersey estate planning attorney, new jersey estate planning lawyer, New Jersey personal injury settlement consultant, New Jersey Special Needs attorney, New Jersey Special Needs Lawyer, New Jersey Special Needs planning, new jersey veterans law, nj elder, nj estate planning, nj estate planning attorney