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General Programs
New Jersey has a number of programs designed to assist eligible
residents in receiving needed medical care and services. There are
varied income and asset limits for most of these programs. A description
of these programs follows. Generally speaking, these programs are
administered by the Division of Aging and Community Services, NJ
Department of Health and Senior Services, PO Box 807, Trenton, NJ
08625-0807.
Pharmaceutical Assistance to the Aged and Disabled
(PAAD)
You are eligible to participate in the Pharmaceutical Assistance to the Aged and Disabled Program (PAAD) if you meet the following requirements:
- You are 65 years of age or older, OR, at least 18 years of age and receiving Social Security disability benefits;
- You are single, and meet the annually established income requirements OR, you are married or in a civil union and your joint annual income meets the annually established income limits. All sources of income, including Social Security and Medicare Part B premiums, if paid, are counted as income. NOTE: The annual income eligibility limits are increased by the amount of the maximum Social Security benefit cost-of-living increase for that year.
- You have been a NJ resident at a permanent address for at least 30 days before applying and your residence is not seasonal or temporary but a legally established residence;
- You do not have equal or superior prescription coverage through another source. If you have only partial or limited coverage, you are eligible;
- You enroll in a Medicare Part D Prescription Drug Plan.
To apply, a PAAD application form must be completed. Application forms can be found at senior citizen centers, Medicaid offices, local pharmacies or the Area Agencies on Aging. A husband and wife must file separate applications.
A new federal program offering prescription drug coverage for Medicare beneficiaries began on January 1, 2006. This coverage is provided through private companies whose plans are approved by Medicare. All PAAD beneficiaries enrolled in Medicare Part B must join a Medicare prescription drug plan. If you choose a Medicare Part D Prescription Drug Plan that is at or below the average cost, you will NOT have to pay premiums, deductibles, or any out-of-pocket costs. With the PAAD card, participants must pay $5.00 for generic drugs and $7.00 for brand name drugs and the State pays the remainder. Only drugs approved by the U.S. Food and Drug Administration are covered. Drugs purchased outside the State of NJ are not covered, nor any pharmaceutical products whose manufacturer has not agreed to provide rebates to the State of New Jersey.
PAAD allows up to a 34-day supply or 100 doses whichever is greater of a drug when this amount is medically necessary and prescribed by your physician.
Once PAAD has determined your eligibility, you should receive an identification card within 30 days.
For the annual income limits or additional information, please contact PAAD, Division of Senior Benefits and Utilization Management, NJ Department of Health & Senior Services, PO Box 715, Trenton, NJ 08625-0715, telephone, toll-free, 1-800-792-9745 or 609-588-7048.
Senior Gold Prescription Discount Program (SENIOR GOLD)
The State of New Jersey offers a prescription discount program, Senior Gold. The Senior Gold Prescription Discount Plan makes available prescription coverage to residents who are ineligible for the Pharmaceutical Assistance for the Aged and Disabled (PAAD) program.
A new federal program offering prescription drug coverage for Medicare beneficiaries began on January 1, 2006. This coverage is provided through private companies whose plans are approved by Medicare. All Senior Gold Beneficiaries who are eligible for Medicare Part A or enrolled in Medicare Part B are required to enroll in a Medicare Part D prescription drug plan in order to participate in Senior Gold. If you choose Medicare prescription drug coverage, you MUST pay the premiums and Senior Gold will help you pay for any other out-of-pocket costs. In standard Part D plans, the plan usually pays for 75% of the drug cost during the initial coverage period and 95% of the drug cost during Catastrophic Benefit Period. Senior Gold participants will pay the Senior Gold co-pay of $15 plus 50% of the remainder.
Senior Gold benefits help to make Medicare prescription drug coverage more affordable by reducing any other out-of-pocket costs associated with that coverage, such as deductibles, co-insurance, and the coverage gap known as the "donut hole." You are eligible to participate in the Senior Gold Prescription Discount Program if you meet the following requirements:
- A New Jersey resident;
- 65 years of age or older or 18 years of age or older and receiving Social Security Title II Disability benefits; and
- You meet the program’s annual income limit (limit is $10,000 higher than for PAAD);
- You enroll in a Medicare Part D Prescription Drug Plan.
Applications are available from Senior Gold, local pharmacies, senior centers or the County Office on Aging. For the annual income limits or additional information, please contact Senior Gold, Division of Senior Benefits and Utilization Management, NJ Department of Heath & Senior Services, PO Box 724, Trenton, NJ 08625-0724, telephone toll-free, 1-800-792-9745 or 609-588-7048, www.njsrgold.gov.
Hearing Aid Assistance to the Aged & Disabled (HAAAD)
The State of New Jersey offers hearing aid assistance for persons
not otherwise qualified for Medicaid who meet the age/disability,
income and residency requirements of the Pharmaceutical Assistance
to the Aged and Disabled Program (PAAD). A person eligible for assistance
under the Hearing Aid Assistance to the Aged & Disabled (HAAAD) program
is entitled to receive up to $100.00 toward the purchase
of a hearing aid.
For further information, please contact the HAAAD,
Division of Senior Benefits and Utilization Management, NJ Department
of Health & Senior Services, PO Box 715, Trenton, NJ 08625-0715,
telephone, toll-free, 1-800-792-9745 or 609-588-7030.
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New Jersey Care . . . Special Medicaid Program
(Includes Qualified Medicare Beneficiary (QMB))
New Jersey Care provides full Medicaid
coverage to NJ residents who are 65 or older, or blind, or permanently
disabled as defined by the Social Security Administration, and who
meet specified income and asset guidelines. If you are eligible,
New Jersey Care will also pick up the cost of your monthly Medicare
Part B premium, as well as your Medicare Part A premium, if you
are required to pay for it. Certain unearned income may be disregarded.
For those enrolled in Medicare Part B, the monthly premium is considered
income and must be included in determining eligibility. Regulations
regarding resources and spousal impoverishment provisions of the
Medicare Catastrophic Coverage Act of 1988 are equally applicable.
For further information, please contact your County Board of Social
Services/County Welfare Board or call 1-800-356-1561.
NOTE: The federal Specified Low-Income Medicare
Beneficiary (SLMB) program, which pays for the Medicare
Part B premium only, has slightly higher income guidelines but the
same asset guidelines as the New Jersey Care program. If you do
not qualify for the New Jersey Care program, but would like to find
out if your qualify for the SLMB program, please contact the New
Jersey Department of Health and Senior Services at 1-800-792-9745
or 609-588-7281.
Medically Needy Program
New Jersey's Medically Needy Program is designed to assist certain
NJ residents, not eligible for Medicaid, to receive medical care
and services. Among those eligible for consideration are persons
65 and older, or blind, or disabled as defined by the Social Security
Administration. Also included is long-term care and related pharmacy
services for eligible individuals residing in Medicaid participating
nursing facilities. The program is designed for eligible persons
with excessive medical bills, which cause the income to be "spent
down" to current Medicaid eligibility income. The Medically Needy
Program offers basically the same services as Medicaid.
People who qualify for the Medically Needy program are entitled to most Medicaid services except for inpatient hospital care and prescribed drugs. Long-term care services are covered.
The Medically Needy Program is administered by the Division of
Medical Assistance & Health Services, NJ Department of Human Services.
To find out if you qualify for the program, or for more information,
contact your County Board of Social
Services/County Welfare Agency
or call 1-800-356-1561.
Institutional-Medicaid
Applicants for the Institutional Medicaid program are considered on an individual basis and the eligibility process is complex. Once eligibility is established, full Medicaid long-term care and related pharmacy services coverage is provided for eligible individuals residing in Medicaid participating nursing facilities. An eligible individual residing in a facility must apply their individual income to offset the cost of their institutional care.
For more information, please call 1-800-356-1561 or you can obtain the address of your local Medical Assistance Customer Center at website http://www.state.nj.us/humanservices/dmahs/info/resources/macc/index.html.
Global Options (GO) for Long-Term Care
The Medicaid Waivers Community Care Program for the Elderly and Disabled (CCPED) is changed to include services in the Assisted Living (AL) Medicaid Waiver. Services through Enhanced Community Options and Assisted Living are terminated. These changes were implemented to develop a long term care system that will enable “money to follow the person”. Medicaid-eligible individuals will be able to receive the services and supports they need in the settings of their choice. As the participant’s specific needs and preferences change, efficiency and access to greater cost effective services are provided. These waiver services will supplement as well as support services provided by families and communities.
Global Options (GO) makes access to services faster, easier and allows greater choice in care. (1) Participants will have the options to hire and direct their own service providers; (2) participants will work with a care manager to create an individualized plan of care; (3) care managers will have greater flexibility in modifying individual care plans as needs and preferences change over time; (4) caregivers will be able to continue in their role as primary support providers and (5) participants will have easier access to long-term care funding to improve support for in-home services and important home and community-based services.
Eligibility requirements are:
- An Individual who is assessed by a state Community Choice counselor or an aging and disability assessor as clinically and financially eligible for Medicaid nursing facility level of care;
- Must be 65 years or older or between the ages of 21 and 64 who shall be determined disabled by Social Security Administration (SSA) or be determined disabled by the Division of Medical Assistance and Health Services, Disability Review Section and;
- There is a reasonable indication that the recipient might need the level of care provided in a hospital, a nursing facility or an intermediate care facility in a month or less.
For additional information contact your local Area Agency on Aging at 1-877-222-3737.
Global Options (GO) Nursing Facility Transition (NFT)
Global Options (GO) Nursing Facility Transition (NFT) is a long-term care initiative that allows certain nursing facility residents to receive supportive services that enables them to return to the community. Funds from home and community based services and institutionally based care are equitably distributed to allow individuals to select a variety of support services for the provision of a comprehensive plan of care for the individual in a setting of their choice. Individuals must be able to direct one’s own care.
Support services for GO NFT participants can be provided by community agencies or qualified Participant Employed Providers that can include family members, friends, or neighbors. All providers must meet qualification requirements which have been approved by the federal government.
Eligibility requirements are:
- An Individual who is clinically and financially approved for nursing home level of care through Medicaid;
- A resident in a nursing facility;
- Assessed by a State Community Choice Counselor for transition back to the community;
- Planned discharge has been coordinated through the Interdisciplinary Team.
Individuals interested in receiving service through Global Options (GO) Nursing Facility Transition (NFT) may contact NJ EASE at 1-877-222-3737. For additional information please contact the NJ Department of Health and Senior Services, Division of Aging and Community Services, telephone, toll-free, 1-877-856-0877.
Jersey Assistance for Community Caregiving (JACC)
Jersey Assistance for Community Caregiving (JACC) provides a broad array
of in-home services and supports that enable an individual at risk
of placement in a nursing facility to remain at home. JACC is a
cost-sharing program intended to supplement and strengthen the capacity
of caregivers as well as delay/prevent placement in a nursing facility.
An individual may be eligible for JACC if he or she:
- Is 60 years of age or older;
- Resides in a home which is he/she owns, rents, or is the home
of a relative that is not licensed;
- Is financially ineligible for Medicaid or Medicaid waiver services;
- Has countable resources at or below the established amount;
- Has no alternate means available to secure needed services and/or
supports;
- Has been determined to be clinically eligible for nursing facility
level of care;
- Is a United States Citizen or a Qualified Alien;
- Has income that is a cost sharing of less than 100% of service
costs.
Inquiries can be directed to NJ EASE telephone, toll-free, 1-877-222-3737. For additional information, please contact the Division of Aging and Community
Services, NJ Department of Health and Senior Services, PO Box 807,
Trenton, NJ 08625-0807, telephone, 1-800-792-8820.
Programs of All-Inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program that allows people who need nursing home level of care to remain in their homes. PACE provides all needed medical and supportive services while helping participants remain independent as long as possible. PACE becomes the sole source of services for eligible enrollees and assumes full financial risk for participants' care without limits on amount, duration, or scope of services. With PACE, inability to pay will never keep you from getting the care you need.
Eligibility requirements are:
- Participants must be at least 55 years old,
- Live in the PACE service area
- Be certified as eligible for nursing home care
- Be capable of living safely in the community at the time of enrollment
- Allow the PACE program to become the sole source of services
PACE is a cooperative program with the United States Department of Health and Human Services (USDHHS). In New Jersey, the Department of Health and Senior Services is responsible for overseeing the program. Individuals interested in receiving service through PACE may contact NJ EASE at 1-877-222-3737.
For additional information please contact the NJ Department of Health and Senior Services, Division of Aging and Community Services, telephone, toll-free, 1-800-792-8820.
Personal Assistance Services Program
The Personal Assistance Services Program is designed to provide
assistance to physically disabled NJ residents age 18 to 65 to enable
them to live independently and participate in community-based activities.
Through this program, participants will be provided with up to 40
hours per week of personal services to assist them in the performance
of routine, nonmedical tasks, that are directly related to maintaining
their health and independence in order to enable them to be employed
or receive training or education related to employment, or to support
community-based independent living. Depending on family income,
some individuals pay no fee. Others pay a portion of the cost on
a sliding fee scale, based on their income.
For the provider agency in your county, persons 60 to 65 should
contact their Area Agency on Aging. All others should contact the
State Division of Disability Services, NJ Department of Human Services,
PO Box 700, Trenton, NJ 08625-0700, telephone, toll-free 1-888-285-3036
or 609-292-7800.
Respite Care Program
The State of New Jersey offers a Statewide Respite Care Program
to provide respite services to families and other uncompensated
caregivers experiencing fatigue and stress due to long-term caregiving
of frail elderly and/or functionally impaired persons 18 years of
age or older. Through these services, caregivers are given relief
from the physical and emotional demands of caregiving. The services
provided are temporary, short-term and intermittent in nature. They
include:
- Companion;
- Homemaker/Home Health Aide;
- Medical adult day care;
- Social adult day care;
- Short-term in-patient care in a licensed medical facility.
Priority is given to those families where the impaired member is
at risk of long-term care institutionalization due to inability
of a caregiver to continue in that role. The individual requiring
care is the only one whose income is considered when establishing
eligibility for participation in this program. While the NJ Department
of Health and Senior Services provides overall administration of the
program, a sponsor agency in each county administers the program
locally.
For further information regarding the location of the sponsoring agency in your county, please contact your Area Agency on Aging toll-free at 1-877-222-3737 or the Department of Health and Senior Services, Division of Aging and Community Services, PO Box 807, Trenton, NJ 08625-0807, telephone 609-943-4985.
Alzheimer's Adult Day Services Program
The State of New Jersey, through its Alzheimer's Adult Day Services Program, provides for specialized programs statewide that serve people with chronic progressive dementing
diseases and their caregivers. The State pays the participating day care center a percent of the daily cost of adult day care and the remaining percent that the State does not pay comes from participant co-payments or other sources as determined by the participating day care center. Persons eligible for this program are those who
are:
- Diagnosed by a licensed physician as having Alzheimer's disease
or a related disorder/disease;
- Cared for or supervised by a family member or other informal caregiver;
- Residing in the community, but who are not residents of a rooming/boarding
home;
- Determined income eligible.
Programs and services offered under this program
include: (a) health monitoring, (b) counseling, (c) recreation, (d)
socialization, (e) nutritional meals, (f) caregiver education, (g)
support groups, (h) information and referrals.
For information on whether this program is available in your community,
please contact your Area Agency on Aging toll-free at 1-877-222-3737. This program is administered
by the Department of Health and Senior Services, Division of Aging
and Community Services, PO Box 807, Trenton, NJ 08625-0807, telephone, toll-free,
1-800-792-8820 or 609-943-3475.
Community Choice Program
The statewide Community Choice Program is designed to select
short-term Medicaid nursing facility residents and provide them
with choices on community-based alternatives to residing in a nursing
facility. The resident's discharge is coordinated with other state
and community agencies and necessary support services are provided
to help make the transition from a nursing facility to community
housing. Through this program Counselors:
- Provide information on special housing, community programs and
in-home services;
- Explain any financial or medical requirements;
- Coordinate with your discharge planner to find services that
support dignity, choice and independence;
- Help you and your family make arrangements so that you will
be happy, safe and cared for in an appropriate community setting.
Please contact the Division of Aging and Community Services, Department
of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807,
telephone, toll-free, 1-877-856-0877 or 609-943-5240.
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Institutional
Long-Term Care Facilities
Persons in long-term care facilities who are Medicaid eligible are entitled
to receive a monthly Personal Needs Allowance. Beneficiaries with
Veterans Administration Improved Pensions may receive slightly higher
amounts.
For information please contact your County Board of Social Services/ Welfare Agency.
Hospital Respite Care Programs
for Senior Citizens
In accordance with P.L. 1986, Chapter 11, general hospitals in
NJ with an average of 20 percent or more weekend vacancy rate over
a six-month period may establish a Hospital Respite Care Program
for persons 65 or older. Under this program, otherwise empty hospital
facilities, in a section separate from medical and surgical patients,
may be used to provide shelter, food, recreation, and supervision
to persons dependent mainly upon family members or others for their
care.
For information on whether any hospital in your area has this
program, please contact your Area Agency on Aging. Any hospital
wishing to
start this program, should contact the NJ Department of Health
and Senior Services, Licensing Program, PO Box 367, Trenton, NJ
08625-0367,
telephone 609-292-9900.
Boarding Homes/Residential Health Care
Facilities
Residents of boarding homes and residential health care facilities who are eligible for Supplemental Security Income (SSI)
or General Public Assistance are entitled to receive a monthly personal
needs allowance. SSI recipients who receive their own checks do
not receive a personal needs allowance.
For information, please contact your County Board of Social Services/
Welfare Agency.
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Nursing Homes
Selection/Evaluation
To assist persons in selecting a nursing home or a residential
health care facility, the Division of Health Facilities Evaluation and Licensing, NJ Department of Health and Senior Services, offers "Selecting a Long-Term Care Facility: A Guide for New Jersey Consumers," which
contains general information & location of these facilities by county.
In addition, the division maintains a deficiency profile on each
nursing home, indicating its size, staff to patient ratio, and the
number of valid complaints about the facility.
For more information,
please contact the Division of Health Facilities Evaluation and Licensing, Department
of Health and Senior Services, PO Box 367, Trenton, NJ 08625-0367,
telephone, toll-free, 1-800-367-6543, or call 609-633-8990.
Nursing Home Pre-Admission Screening Program
The State of New Jersey has a Nursing Home Pre-Admission Screening
Program to determine the needs of Medicaid-eligible individuals,
or individuals who will be Medicaid eligible following admission
to nursing facilities prior to placement in such facilities.
The Nursing Home Pre-Admission Screening Program is administered
by the Division of Aging and Community Services, Office of Community
Choice Options, Department of Health and Senior Services, PO
Box 807, Trenton, NJ 08625-0807, telephone 609-943-4978 or toll-free
1-877-856-0877.
Nursing Home Services
All nursing homes are required to provide services to meet the
total needs of their patients. Services to be provided include:
(a) medical and nursing, (b) diagnostic, (c) dental, (d) pharmaceutical,
(e) rehabilitative, (f) dietary, (g) recreational and social, and
(h) religious.
For further information, or to file a complaint regarding services,
please contact the Division of Health Facilities Evaluation and Licensing, NJ Department
of Health and Senior Services, PO Box 367, Trenton, NJ 08625-0367,
telephone 1-800-792-9770 or 609-633-8991. For complaints concerning
mistreatment of patients in a nursing home, age 60+, contact the
Ombudsman for the Institutionalized Elderly, PO Box 852, Trenton,
NJ 08625-0852, telephone 1-877-582-6995 or 609-943-4023.
"Medicaid" Beds
Nursing homes are required to maintain a bed for a period of up
to ten days for any resident receiving Medicaid payments who is
absent from the facility due to hospital admission or therapeutic
leave. In addition, such a person shall continue to be covered by
Medicaid for the number of days (up to ten) that the nursing home
maintains his/her bed. Should a resident not be able to return to
the nursing home before the end of the ten-day period, he/she will
have priority for the next available bed in the facility.
For further information, please contact the Office of Community
Choice Options, Department of Health and Senior Services, PO Box
807, Trenton,
NJ 08625-0807, telephone 609-943-4978, or toll-free 1-877-856-0877.
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