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.
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