NJ Medicaid Paying for Home Care? Not So Fast
This article was updated in January 2017.
I talk a lot about Medicaid in New Jersey. I could probably continue to talk about it for the rest of my natural born life, such are the complications and red tape that are involved in administering the program. The State has managed to take a program that thousands of seniors rely on and turn it into an industry supporting tens of thousands of others, at great cost and inconvenience to seniors and caregivers statewide. This article, which I saw in the Star-Ledger when I first starting writing about this topic in 2013, starts to get at some of the problems. Does Medicaid cover home care in New Jersey? Sort of. It may not meet your expectations.
There are many different “flavors” of Medicaid in New Jersey, including a number of so-called “waiver” programs. There is one that covers home care at the moment, but only so many hours as a care manager in the state’s employ says you can have. The tool is based on the assumption that approximately 40 hours per week of care is the normal upper bound. I’ve seen higher numbers, but under no circumstances does the program cover 24/7 care in the home. In addition, in order to qualify for the program, the applicant’s assets must be below $2,000 (the house doesn’t count) and the applicant can only keep approximately $2,200 a month in income. Let me know if you think you can pay your property taxes with $2,200 a month and still pay the bills, put food on the table, and pay for prescription medication. It’s not a lot of money, is it?
The current system is something called a “comprehensive waiver” program, in which the State provides care in a variety of different settings and they’re all covered by the same rules. The State has given up its administration of the care itself and subcontracted it out to private insurance companies (a process known as “managed care,” which you are probably familiar with if your health insurance is with an HMO). The State pays those companies a daily rate for every person covered by them, and it’s the insurance company’s job to make sure they can pay for the care and make a profit. You can see how that might cause conflict between the State, the beneficiaries, and the insurance companies themselves.
If you want to talk about the process or about how the State might be able to care for an ailing relative in the months and years ahead, give me a call. There are options aside from institutional care, but with those it’s especially important to plan ahead before a crisis hits. The program may then be too slow to respond or have too little coverage to make it useful for families.
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