Assisted Living In New Jersey That Accepts Medicaid

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Assisted Living Admission Requirements

Applying for Medicaid Eligibility For Long Term Care in NJ (Part I)

New Jersey assisted living facilities have no restrictions or requirements that limit admission. However, if a resident does require long-term, specialized care, such as needing continued access to respirators or needing intensive behavioral management, mandatory discharge is required. Additional discharge requirements are left up to the discretion of the facility. These may include prolonged illnesses that require 24-hour nursing, or a resident becoming a danger to themselves or others.

An initial assessment must be conducted for all residents upon admission to determine the needs of the resident. A healthcare assessment should be completed within 14 days of admission if the initial assessment shows that the resident has specific health needs, and may only be conducted by a registered nurse or medical professional employed by either the facility or the DOH. Residents must also have continued reassessments in a time frame that is consistent with their health service plan.

The Benefits Of Assisted Living

There are many benefits to assisted living. Here are just a few:

  • Peace of mind. Most assisted living communities offer emergency response and security systems campus-wide. If anything should happen to your parent, someone will be there to take care of them. No more worrying in the middle of the night whether theyve fallen or not no more wondering why they arent picking up the phone.
  • Quality care. At an assisted living community, your parent will have the assistance they need as they go about their day, from their first cup of coffee to their nighttime routine. Theyll still have agency to act on their own, but at the same time theyll have help with things such as medication management, bathing, or dressing.
  • Lifestyle options. Of course, your parent is more than their health needs. The assisted living communities of today are focused on offering social activities, cultural programs, group outings, gourmet dining, and even professional entertainment. Residents can be as social as they want and are free to do as they please.
  • Transferring

An Overview Of New Jerseys Assisted Living Regulations

An Overview of New Jerseys Assisted Living Regulations

New Jersey, like all states, has its own set of assisted living rules and regulations. Additionally, how New Jersey defines assisted living can be different from most other states.

This is where the assisted living industry can be confusing to families researching care. Often times, families are researching for a loved-one across state lines, and what may fall within the boundaries of law in one state may not in another.

This is where knowing about specific State regulations for assisted living and long-term care is essential for making informed decisions based on accurate information from trusted publications and agencies.

First, for New Jersey, its helpful to know who is responsible for the oversight and regulation of assisted living throughout the state.

This title goes to the New Jersey Department of Health, and their Division of Health Facilities Evaluation and Regulation.

Their site looks like this:

The Department of Health regulates a wide range of health care settings for quality of care, such as hospitals, nursing homes, assisted living residences, ambulatory care centers, home health care, medical day care and others. The full list includes:

  • Adult Day Care Services
  • Nursing Home
  • and more.

The full list includes a short definition of the service, which is unique to New Jersey.

Learn more about filing a complaint and hotlines for New Jersey here:

How to see New Jerseys Assisted Living Regulations:

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Does My Parent Need Assisted Living

Still not sure if your parent needs assisted living? Lets go over a few example scenarios to help clear things up:

SCENARIO #1

Is Mary a good fit?

Yes. Most important, in an assisted living community, Mary could receive help with medication management. Meals would also be provided, and the housekeeping would be taken care of for her.

SCENARIO #2

Richard

Richard suffered a fall and hospitalization about three months ago. He has since recovered, but his children are worried. Hes a bit unsteady on his feet, and although he insists hes fine, theyve noticed that he has issues getting around the house and dressing himself. He used to love being out and about, but now hes always at home.

Is Richard a good fit?

Yes. When mobility becomes a concern, assisted living can be a good fit. The suites are designed with senior needs in mind, and theres a trained, professional staff available around the clock in the event of a fall, or if Richard needs help getting dressed in the mornings. Additionally, there will be plenty of activities and programs to get him back to his social self.

SCENARIO #3

Dottie

Dotties daughter has noticed recently that Dottie isnt cooking anymore. She usually goes out to eat or heats up frozen meals. Also, the house is getting messy. When her daughter asks her if everythings okay, Dottie is dismissive and says she just doesnt bother with it anymore.

Is Dottie a good fit?

Researching assisted living? We have resources that can help.

How To Pay For Assisted Living

Form AL

There are a few ways people usually pay for assisted living: Private funds, long-term care insurance, veterans benefits, or Medicaid. Since licensed assisted living communities follow state guidelines, they typically are limited in the amount of specialized medical care they can provide, if any, so Medicare usually does not cover the cost.

  • Private Funds: Many people pay through private means, whether that be personal investment portfolios, savings accounts, pensions, or the profits from a home sale.
  • Long-Term Care Insurance: If you have long-term care insurance, it may be able to cover assisted living. Most policies have restrictions in place, so its best to call the insurance company with any questions.
  • Veterans Benefits: The Veterans Administrations Aid and Attendance pension has benefits that cover a veteran or veterans spouse who needs regular assistance. Assisted living falls under this benefit.
  • Medicaid: Medicaid covers assisted living costs, though the coverage, financial aid, and eligibility of a person differ from state to state. Additionally, not all communities accept Medicaid. Note: By contrast, Medicare does not usually cover the cost of assisted living.

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Paying For Senior Care With Ssi

Social Security Supplemental Income payments are provided on a monthly basis and can be used for a variety of expenses. Some seniors may choose to use their payments to cover the cost of their food, entertainment, shelter, clothing or even medical care. An income threshold must be met in order to qualify for SSI. Most seniors who are able to receive SSI also qualify for Medicare. The government benefit eligibility screening tool is a great way to see if you or your loved one qualifies for SSI, SSDI, Medicare, veterans benefits or any other federal senior assistance programs.

Most assisted living communities will have several different payment options for seniors, including those who would like to use SSI, SSD, or OSS benefits. In some facilities, seniors may use their full SSI benefits to cover their full expenses. Not every assisted living community will provide subsidies for their monthly fees for those on SSI, so it is important to check the location’s rules prior to enrollment. Seniors who require skilled nursing care can use a combination of Medicaid and SSI for their care. Other senior care payment options are PACE, Long term care insurance, veterans aid, and life settlements. Every senior will face a different set of circumstances, and it is important to keep current and future health complications in mind when choosing a payment option.

Managed Long Term Services And Supports

The MLTSS program is focused on serving frail, elderly, and disabled individuals. This program combines traditional health care benefits and long term services and supports such as:

  • Care Management. Someone to get you the care and support needed.
  • Home and Vehicle Modifications. In-home medical and safety equipment are covered, plus needed modifications to a vehicle.
  • Home Meal Delivery. If you can’t safely make meals, we’ll provide them.
  • Mental Health & Addiction Services. Counseling and other treatments are covered.
  • Personal Emergency Response System. Sends an urgent request for someone to help you.
  • Adult Day Care. Friendship and social activities in a safe setting.
  • Respite Care. In-home help to give your caregiver a rest.
  • Personal Care. Someone to help with dressing, bathing and dining.

Learn more about the MLTSS program here

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American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Get The Insights You Need To Find The Right City

Medicaid Financing and Coverage Issues in Assisted Living

Families looking for assisted living in New Jersey have a wide array of communities to choose from, since estimated that there are more than 30,000 assisted living communities serving seniors across the U.S., and over 262 statewide. The state is also home to a rapidly growing number of senior citizens, with adults over 65 making up an estimated 16 percent of the population. A resident in an assisted living community in New Jersey will pay $6,065 per month on average.

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Pet Friendly Amenities In New Jersey Assisted Living Facilities

For some seniors that have lived with a cat or dog for years, possibly decades, the thought of abandoning their beloved pet is impossible. Pets become family just like humans. Finding a pet friendly assisted living center is necessary in such cases.

What amenities should you expect to find? Or what questions should you ask? Every assisted living facility is different, but if you make it clear from the start living with a cat or dog is important than they should also take time to overview the various amenities for pets they may feature.

For example, some pet friendly assisted living communities in New Jersey go as far as to feature a pet spa. Here you can get your favorite furry friend a day in luxury including grooming.

More practical services in assisted livings in NJ can include things like a pet sitting service that watches after an animal while you are gone. Kind of like doggy day care. Then there are pet walking services that will help get the animal exercise in the event the senior cannot.

Assisted Living Admissions & Ssi

Assisted living communities will accept seniors who utilize SSI, SSD, & OSS. However, the rate of acceptance is lower than those who use private insurance and self-payment options. There is no law that requires RCFEs to accept admissions from seniors who are on SSI, but usually, seniors with lower care requirements will be readily admitted.

The disparity in acceptance of seniors on SSI, SSD, & OSS is mainly caused by the lower payment amounts as opposed to their care needs. Most assisted living facilities are for-profit, so it makes sense for them to admit residents who offer them a higher profit margin. While this may seem unfair, there are many assisted living homes that will accept residents who will use SSI payments to cover costs of care.

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Residential Health Care Facilities

Residential Health Care facilities cater to residents who are able to get around on their own, are not in need of 24-hour skilled nursing care and are able to perform activities of daily living with minimal assistance. The services offered are often very similar to those offered in assisted living residences. The facility provides 24-hour protective oversight, personal care services , medication supervision and assistance, transportation and recreational activities. Health maintenance and monitoring services are provided under the direction of a registered professional nurse.

Residential Health Care Facilities promote maximum independence and offer semi-private and private rooms with or without private bathrooms, and common areas for dining and recreation. Three meals a day are served in the common dining room. Housekeeping and maintenance service is also provided. Staff are usually responsible for assisting in obtaining medical and social services. Some provide assistance for special needs, such as for those using oxygen and assistive devices, or with behavioral health or cognitive impairments. Residential health care facilities are regulated by the New Jersey Department of Health and the Department of Community Affairs. The are subject to unannounced annual inspections by these agencies.

The administrator of a residential health care facility must be licensed or certified by the New Jersey Department of Health.

Thoughts On Learn Which Facilities In Nj Accept Medicare Or Medicaid

Does Medicaid Cover In
  • sara fuentes

    Hello. Im a unit manager in New Jersey looking for a assisted living willing to take a patient with medicaid. Can I please get a list of facilities that can help place our beloved resident.

  • tina basilovecchio

    please help me find assistant living in new jersey that accepts medicade

  • Lynn Williams

    Im looking for an assisted living facility for my mother that accepts medicaid early on. Im finding that most of the places wont accept until two years in. She receives S.S. and a minimal amount of money in the bank.

  • Robin Huziarski

    Are there any assisted living facilities available for my mother shes on social security, if so when.?

  • stephen w. nyers

    iam seeking long term Medicaid assisted living facilitiy for myseif

  • Lynne Brownlow

    I am seeking an assisted living facility for my mother that accepts Medicaid, in the Trenton area or Ocean County. She is 91 yrs. old, and only has her social security.

  • Erika Reading
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    Comprehensive Personal Care Home

    A Comprehensive Personal Care Home is a facility thats approved by the Department of Health to provide:

    • Assisted Living Services
    • Arrange for resident transportation to and from health care services

    In a CPCH:

    • The stove in the kitchen can be removed if it is a safety hazard
    • There is a front door that can be locked from inside
    • You can get to your own apartment kitchen at any time to get food and drinks
    • You may share a unit with another person

    You cannot receive this service at the same time as:

    • Adult Day Health services
    • Adult Family Care services
    • Assisted Living Program
    • Home Based Supportive Care
    • Home-Delivered meals
    • Personal Emergency Response System
    • Residential Modifications

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    Unitedhealthcare Dual Complete Plans

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

    Resource Limit For Long

    Senior Planning Services, NJ Medicaid and Qualified Income Trust

    You must have few resources in order to qualify financially for Medicaid. In New Jersey, applicants for long-term care can have assets up to $2,000, or $3,000 for a married couple with both spouses applying. For applicants to regular Medicaid , the resource limits are higher, so that an individual can have up to $4,000 in resources and still qualify. A couple with both spouses applying can have up to $6,000 in assets.

    People who qualify for the Medically Needy Program are also allowed up to $4,000 in resources, or $6,000 for a couple with both applying. Keep in mind that if you are entering a nursing home and your spouse is not, you will be allowed to keep extra income and resources to support your spouse, according to New Jersey’s “community spouse allowance” rules.

    Not all property counts toward the resource limit. In New Jersey, your home is an exempt resource as long as it is your principal residence. But when you live away from your home for six months , it is presumed to not be your principal residence anymore — unless your spouse still lives there. Also, one car is exempt regardless of its value, as long as you or a family member uses it for transportation.

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    Assisted Living Facility Requirements

    In order to receive a license from the Department of Human Services, assisted living facilities must adhere to specific guidelines on room size and facility safety set forth by the DOHS:

    • Private units in a facility should have no less than 150 sq ft of space, while semi-private units must have an additional 80 sq ft of space per resident.
    • The square footage requirement should be clear usable space and as such excludes bathrooms, kitchenettes, closets, hallways, corridors, foyers, and vestibules.
    • At maximum, a unit may contain two residents.
    • Each unit must contain a bathroom, shower or bathtub, and a sink.
    • The facility should have sufficient public toilet areas to meet the need of residents, staff, and visitors to the facility.
    • Unless an exemption has been granted by the DOHS, all facilities must have an automatic fire suppression system in place throughout the facility.
    • Smoke detectors are required in all resident bedrooms, living rooms, studio units, and apartments, as well as common areas.

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