Medical Assistance
Medicaid Managed Long Term Services and Supports (MLTSS)
This refers to the delivery of long-term services and supports through New Jersey Medicaid's NJ FamilyCare managed care program. MLTSS is designed to expand home and community-based services, promote community inclusion, and ensure quality and efficiency.
MLTSS uses NJ FamilyCare managed care organizations (also known as HMOs or health plans) to coordinate ALL services. MLTSS provides comprehensive services and supports, whether at home, in an assisted living facility, in community residential services, or in a nursing home.
What does MLTSS cover?
- Personal Care;
- Respite;
- Care Management;
- Home and vehicle modifications;
- Home Delivered Meals;
- Personal Emergency Response Systems;
- Mental Health and Addiction Services;
- Assisted Living;
- Community Residential Services;
- Nursing Home Care.
How is Nursing Home Care covered in MLTSS?
Any individuals with NJ FamilyCare entering a nursing home for the first time will have their acute and primary health care managed by the NJ FamilyCare MCOs with MLTSS or the Program of All-Inclusive Care for the Elderly (PACE) program. Individuals on MLTSS also will have their acute and primary health care services and nursing home care managed by a NJ FamilyCare MCO.
How to qualify for MLTSS?
A person can qualify for Managed Long-Term Services and Supports (MLTSS) by meeting these established Medicaid requirements:
- Financial Requirements: These include monthly income, as well as total liquid assets. For more detailed information on Medicaid financial eligibility, click here: https://www.state.nj.us/humanservices/dmahs/clients/medicaid/abd/
- Note that for children applying for MLTSS and who meet the nursing home level of care, parental income and resources are not counted in determining financial eligibility.
- Clinical Requirements: A person meets the qualifications for nursing home level of care, which means that the person requires assistance with activities of daily living such as bathing, toileting, and mobility.
- Age and/or Disability Requirements: These involve age requirements whereby one must be 65 years of age or older and/or disability requirements whereby one must be under 65 years of age and determined to be blind or disabled by the Social Security Administration or the State of New Jersey.
How do I apply for MLTSS?
- Apply in person at our office.
- Review the ABD checklist before filing your application. ABD Checklist
- If you are applying on behalf of your child or an individual under 21 years of age, you can do so by contacting the Monmouth County Division of Social Services at (732) 431-6000 or the Division of Disabilities Services at 1-888-285-3036 (press 2 after prompt and then press 1 after next prompt) to speak with an Information and Referral Specialist.
- Contact the Monmouth County office on Aging at (732)431-7450, Aging and Disability Resource Connection (ADRC).
- You may also apply online at https://njfc.force.com/abd/abdstart
There is another option known as the Program of All-Inclusive Care for the Elderly (PACE) program. To be eligible to enroll, you must live in the PACE provider service area and otherwise be eligible for MLTSS. There currently are four PACE organizations in seven counties. For more information, contact the Monmouth County Division of Social Services or call PACE at 1-800-792-8820.
For more information on all Medicaid programs, visit the NJ Division of Medical Assistance and Health Services website.
NJ FamilyCare
NJ FamilyCare is a publicly funded health insurance for New Jersey residents. It provides free or low-cost quality health care for children and adults.
Who is eligible?
- Qualified New Jersey residents of any age can be eligible for NJ FamilyCare. This includes children, parents, caretaker relatives, and adults without dependent children.
- Eligibility is based on the income and household size reported on the applicant’s latest federal tax return.
- NJ Family Care can also use other sources, such as pay stubs, to verify information. Income eligibility for children is higher than income eligibility for adults.
What is covered?NJ FamilyCare offers full health care coverage through health plans contracted by the state and covers most health care needs, including:
- doctor visits
- x-rays
- eyeglasses
- prescriptions
- hospitalization
- mental health services
- lab tests
- dental
- special visits
- preventive screenings
What Does It Cost?For many people, NJ FamilyCare will cost nothing—no monthly premiums or co-payments.
For higher-income families with children, there is a sliding scale for co-payment and monthly premiums.
Are There Any Restrictions?
Pre-existing conditions do not affect eligibility. In some cases, you must be without medical insurance for at least 3 months to qualify.
Because there are exceptions, it is a good idea to call NJ FamilyCare in case you have a question.
Adults must have legal permanent resident status for at least five years to be eligible. For undocumented residents, their children may be eligible if born in the U.S.
How to apply?
- Complete an application at njfamilycare.org or call 1-800-701-0710 (TTY: 1-800-701-0720).
- Complete an application at a Monmouth County Social Services office or call (732) 431-6000 ext. 4200 to have an application sent to you.
What if I am not eligible?Health Insurance Marketplace®: For individuals and families ineligible for NJ FamilyCare due to income, the federally run Health Insurance Marketplace will help you get coverage that meets your needs and fits your budget.
The NJ FamilyCare Aged, Blind, and Disabled Programs
The NJ FamilyCare Aged, Blind, and Disabled (ABD) Programs are multiple programs for people who need access to health care services in the community, or in long-term care facilities. Information on all the ABD programs is provided in the NJ FamilyCare Aged, Blind, and Disabled Programs brochure.
In determining whether a person is financially eligible for NJ FamilyCare or ABD programs, the applicant’s financial eligibility will be considered along with that of his or her spouse or parents. Use the ABD Checklist to see what you may need in order to apply.
The application process may require additional forms to be completed. The supplemental Designated Authorized Representative and Spouse Information forms must be submitted with your application, if applicable to your situation.
How to apply?
For more information on all Medicaid programs, visit https://www.nj.gov/humanservices/dmahs/home/
Questions?
General Inquiries - Email us at medicaid@co.monmouth.nj.us
Fair Hearing Inquiries – Email us at fairhearing@co.monmouth.nj.us
Due to confidentiality and HIPAA federal and state regulations, you need to include a telephone contact number and/or address when you email us. No responses by the County potentially revealing Protected Health Information can be made via e-mail.