Medicaid Managed Long Term Services and Supports (MLTSS) older then 60yrs.

What is MLTSS?

Managed Long Term Services and Supports (MLTSS) 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?

Managed Long Term Services and Supports (MLTSS) includes:

• Access to all NJ FamilyCare Plan A Benefits;
• Care Management;
• Home and Vehicle Modifications;
• Home Delivered Meals;
• Respite;
• 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 individual with NJ FamilyCare 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 FamilyCare Managed Care Organizations (MCOs). Short-term Rehabilitation stay in a NF/SCNF is a NJ FamilyCare Plan A benefit. Once the individual has completed rehabilitation, the MCO will screen their member to evaluate if they meet the MLTSS criteria. 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).

Any individual who is pending or newly eligible for NJ FamilyCare 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. If the individual is approved both financially and clinically for Medicaid, the individual will be enrolled in MLTSS and in an MCO.

NF/SCNF residents who were considered custodial care on Medicaid prior to July 1, 2014 will remain NJ FamilyCare fee-for-service for the duration of their stay.

 How to qualify for MLTSS?

An individual 21 and older 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.
• Age and/or Disability Requirements: These involve age requirements whereby one must be 65 years 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?

Call us at 908-788-1361 and ask to be screened for services.