Children ages birth through 20 meet clinical eligibility for MLTSS through functional limitations, identified in terms of developmental delay or functional limitations for age-appropriate activities of daily living, and require nursing care over and above routine parenting and meets the criteria for skilled nursing care that requires complex skilled nursing interventions 24 hours per day, seven days a week.An individual 21 years and older meets the clinical eligibility for Nursing Facility level of care, which means the individual requires hands on assistance with three or more activities of daily living such as bathing, dressing, toileting, locomotion, transfers, eating, and bed mobility or has cognitive deficits and requires supervision and cueing with three or more activities of daily living.For more detailed information on Medicaid financial eligibility, click here. Financial Requirements: These include monthly income, as well as total liquid assets.NF/SCNF residents who were considered custodial care on Medicaid prior to Jwill remain NJ Famil圜are fee-for-service for the duration of their stay.Īn individual 21 and older can qualify for Managed Long Term Services and Supports (MLTSS) by meeting these established Medicaid requirements: If the individual is approved both financially and clinically for Medicaid, the individual will be enrolled in MLTSS and in an MCO. If the MLTSS criteria are met and the individual requires long-term custodial care in the nursing facility or community, a clinical assessment for MLTSS will be conducted by the MCOs and a determination of clinical eligibility will be made through the Division of Aging Services (DoAS).Īny individual who is pending or newly eligible for NJ Famil圜are Plan A and is living in, or requesting placement, in a NF/SCNF will be referred to the DoAS Office of Community Options (OCCO) for MLTSS clinical eligibility assessment. Once the individual has completed rehabilitation, the MCO will screen their member to evaluate if they meet the MLTSS criteria. Short-term Rehabilitation stay in a NF/SCNF is a NJ Famil圜are Plan A benefit. How is Nursing Home Care covered in MLTSS?Īny individual with NJ Famil圜are entering a nursing facility (NF) or special care nursing facility (SCNF) for the first time will have their acute and primary health care managed by the NJ Famil圜are Managed Care Organizations (MCOs).
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