New Jersey Care/Special Medicaid Programs

Provides full Medicaid coverage to certain categories of individuals whose income or resources make them ineligible for AFDC or SSI, but who cannot afford proper medical care. It consists of both and AFDC component and an Adult (aged, disabled and blind) component. In the AFDC component, the upper age of eligibility for children is 10 years, and increases by 1 year every October of each year until it reaches 18 years in the year 2002.

Medically Needy Program

Provides some specific medical benefits to certain needy New Jersey residents who may not be able to afford health care services but have income and/or assets that are too high to qualify for the regular Medicaid programs. To be eligible for the program, individuals must be either 65 years old or older, be blind or disabled, be a pregnant woman or be a needy child under 21 years of age. This is the only program which contains a "spend down" component, that is, an applicant who is not immediately income eligible may become eligible after spending a certain amount of income on approved medical bills.

Medicaid in the Community

Provides full Medicaid coverage to individuals residing in the community who are 65 years of age or older, blind or permanently and totally disabled, and whose income and resources do not exceed the SSI standards, but who do not qualify for SSI for other reasons.

Long-Term Care Medicaid

Provides full Medicaid coverage and pays all authorized bills of eligibles in a participating hospital or Long Term Care Facility (Nursing Home). The hospitalization or placement must be of at least 30 days duration and medical need for nursing home placement must be approved by the Medicaid District Office prior to placement. The SMPU also provides a Resource Assessment service to couples where one of the members may be considering future admission to a nursing facility.

Community Care Program for the Elderly & Disabled - CCPED

A program especially designed to help individuals return to the community from a nursing home or to help individuals remain in the community rather than be admitted to a nursing home. An individual plan of care is developed by a case manager that will assure quality care in a cost-effective manner. The program does not provide regular Medicaid coverage (doctor, hospital, prescriptions, etc.) and assumes that the applicant has Medicare and/or other health insurance. It does provide payment for such services as Home Health Services, Homemaker Services, Medical Day Care, Medical Transportation, Respite Care and Social Adult Day Care. The eligibility requirements are essentially the same as for Long Term Care (Nursing Home) Medicaid.

Home Care Model Waiver I & II

Special programs with a maximum of 50 slots each statewide, established to enable individuals with long-term care needs to remain in the community rather than be cared for in a hospital or nursing home. The individual must be a blind or disabled child or adult requiring at least an Intermediate Care Facility level of care and having income and resources below the Long Term Care amount. No deeming of parental or spousal income applies. The program provides full Medicaid coverage except nursing home placement. In addition, case management services are provided to the individual to aid in planning, locating, coordinating and monitoring services selected to meet the individual's health needs.

Home Care Model Waiver III

Limited to 50 slots statewide, this program is essentially the same as Waiver I & II, except that applicants must require a skilled nursing facility level of care and the services of a private-duty nurse. The program provides full Medicaid coverage plus private-duty nursing up to 16 hours per day. Nursing home placement is not covered. Administration is as described above.

AIDS Community Care Alternatives Program - ACCAP

A Medicaid Waiver program administered by the Division of Social Services Special Medicaid Programs Unit (and by SSI for SSI recipients) which allows individuals diagnosed as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) to receive extensive care in the community rather than in a nursing home or hospital. It provides full Medicaid coverage plus an array of special services including private-duty nursing, narcotic and abuse treatments at home and personal care assistant services. Eligibility requirements are essentially the same as those for Long Term Care (Nursing Home) Medicaid.

Hospice Program

Started in September, 1992, this is a program of palliative services provided to the terminally ill in their own home, a nursing facility or a state approved hospice. A whole range of services, including respite care to relieve the caregiver is provided if the applicant selects this program and meets the SSI, NJC or Medicaid CAP financial standards.
 

Traumatic Brain Injury Program

Implemented on July 1, 1993, this is a Federal waiver program which offers home and community-based services to persons disabled by a traumatic brain injury. The purpose of the program is to help eligible individuals remain in, or return to the community rather than be cared for in a nursing facility.