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Medicaid is a benefit provided by our government to pay for Skilled Nursing Facility care with the benefit criteria varying from state to state. New Jersey Medicaid covers persons who are age 65 years or over and persons determined to be blind or disabled by the Social Security Administration or by the Division of Medical Assistance and Health Services. The individual must be a resident in the state they are applying for and a citizen of the United States or lawfully admitted for permanent resident.
Medicaid eligibility starts on the first day of the first month after your resources are equal to or less than $2,000.00 or $4,000.00. The resource limit of $2,000.00 applies to Medicaid only and $4,000.00 applies to applicants of New Jersey Care and special Medicaid programs such as the Medically Needy segment. Excess resources can be spent down by paying privately for care until the appropriate resource limit is reached. In all instances of spending down the resources, assets cannot be transferred for less than fair market value or given away without compensation. Excess funds can also be used to prepay funeral expenses by putting the money into an irrevocable trust.
With regard to couples, Medicaid eligibility will exist on the first day of the first month after a couple’s total resources, less the amount established as the community spouse’s are equal or less than the appropriate resource limit.
The community spouse’s income is not used to determine Medicaid eligibility for the spouse in the nursing facility. In the event that the spouse in the nursing facility becomes eligible for Medicaid, the community spouse is not required to use any of his or her income to pay for the nursing home care of the spouse. Your county Board of Social Services will complete a Spousal Resource Assessment to calculate the community spouse’s share of a couple’s assets.
Countable resources include, but are not limited to:
• Bank accounts
• Property other than your principal residence
• Stocks, bonds, certificates of deposit
• Cash surrender value of life insurance which exceeds $1,500.00 in face value
Resources that are excluded include, but are not limited to:
• A home which
serves as a principal residence of a spouse or other dependent
relative (if a home is not
occupied by a dependent relative and the period of
institutionalization is expected to be
six months or less, the home may also be
excluded)
• Life insurance which does not exceed $1,500.00 in face value
• Burial spaces and
burial funds not exceeding $1,500.00 (less excluded cash
surrender of life insurance
and/or funds held in an irrevocable burial
arrangement)
• One automobile to
the extent that its current market value does not exceed
$4,500.00
• One wedding and engagement ring
NOTE: It is important to remember that in the spend-down process, eligibility cannot be established in any month where, on the first moment of the first day of that month, the resources exceed the resource limit.
For example: an individual has $6,000.00 in a checking account. The applicant owes $4,000.00 to a nursing facility for care. If a check for $4,000.00 is written to the nursing facility on or after May 1, eligibility cannot be established before June 1. The May nursing facility charges would be the responsibility of the applicant.
NOTE: It is also important to remember that Social Security checks as well as any pension checks must be surrendered to the nursing facility.
If you believe that you meet the Medicaid criteria, you should contact your local Board of Social Services or county welfare agency for information concerning the application process.