There are many Medicaid or New Jersey Family Care programs in NJ and each has different eligibility criteria. Here is a brief overview of MLTSS. Keep in mind, the rules are complicated, so if you believe you may be eligible, contact Central Jersey Legal Services (CJLS) for assistance. CJLS is a law firm that provides representation and advice to people who cannot afford an attorney. If you need legal help please contact our Mercer County office at 609-695-6249 to be screened for eligibility.
MLTSS is the Medicaid program that provides a nursing home level of care to low income individuals. It will cover long term care in a nursing facility or assisted living facility, as well as benefits to individuals at home including private duty nursing, home delivered meals, and a personal emergency response system.
A person in need of long-term care must meet both clinical and financial eligibility in order for Medicaid to cover their cost of care. To be financially eligible, there is both a “resource” or asset test and an income test. For resources, the MLTSS applicant must have $2,000 or less in assets, which includes but is not limited to bank accounts, retirement accounts, and the cash value of life insurance. Your residence and one car are exempt if you are receiving services at home and the car is used for your benefit. Term life insurance that does not have a cash value is not considered an asset. If you move to a nursing home, the home may be counted. For married couples, anything belonging to either spouse counts toward resource eligibility but there are rules to prevent spousal impoverishment. The primary marital residence is exempt if the well spouse (known as a community spouse) resides there. There are also complicated rules that are used to calculate the amount of savings the community spouse may keep, while still allowing the MLTSS applicant to qualify.
With respect to the income test, the person seeking MLTSS eligibility must have gross income (income before any deductions), including Social Security or pensions, below $2,982 (2026). The income of the community spouse is not counted, and they get to keep their entire income. Individuals whose income exceeds the income limit may still be eligible for MLTSS if they establish a Qualified Income Trust (QIT). Income that goes into the QIT is not counted for eligibility purposes but must still go toward the person’s cost of care. The rules for QITs are complicated and if it is not done correctly, MLTSS eligibility will be denied, so an attorney’s guidance is highly recommended.
The most complicated part of MLTSS eligibility is the lookback period and transfer penalty. When an individual applies for MLTSS, like applies for Medicaid, they must provide 5 years of financial records. If there has been an improper transfer of assets during the 5-year lookback period, a penalty period of ineligibility will be imposed. When applying for Medicaid, agency workers will review your financial records for the past five years and require proof of where deposits came from and where withdrawals were spent. For that reason, if you may apply for Medicaid in the future, it is important to keep good records of your finances and pay for things in a way that establishes records of where funds were spent.
In addition to the complicated financial criteria, an individual must be found clinically eligible in order to qualify for MLTSS. The Office of Community Choice Options (OCCO) is tasked with the responsibility of determining if an individual meets clinical eligibility for MLTSS. If the applicant is in a nursing facility or assisted living facility at the time of their application, the facility will file a request for a nursing assessment from OCCO. Individuals who are home have the extra burden of making the request.
CJLS provides free civil legal assistance to low-income families. If you have landlord-tenant disputes, domestic violence, social welfare, immigration, consumer and other issues, please call 732-249-7600. We have Chinese-speaking staff to serve you. .
