Most of the time, the caregivers who come into my office desperately want to keep their loved ones at home. They come looking for assistance as the price of private home care is skyrocketing. For my New Jersey clients I cannot always share good news. In this article I will address what options are available for seniors who need long-term care services in their homes and how neighboring states have expanded options to better meet community needs.

Qualifying for Homecare Services

It is not easy to qualify for Medicaid coverage of homecare services. First, there are stringent financial criteria. There are also medical need criteria. To qualify, a person must need assistance with three of the basic daily life skills (eating, dressing, bathing, toileting, transfer and ambulation). Many individuals, especially those with cognitive impairment, need daily care but can still manage these tasks.

The sobering reality is, the New Jersey Medicaid community supports program (under the MLTSS – Managed Long Term Services and Support Program) is insufficient for many families. It typically provides home health aide services limited to 40-50 hours per week and, with limited exceptions, does not include overnight care. Therefore, while the applicant’s needs must be quite high to qualify, the way the number of hours approved is calculated (focusing on specific daily life skills that the aide will assist with) can often leave substantial needs unaddressed. A recent federal study also found that New Jersey failed to adequately assess and meet the needs beneficiaries under the MLTSS program.

Veterans may be able to receive a wider array of services (either in conjunction with Medicaid or prior to becoming Medicaid eligible). Services are available through the New Jersey Veterans Health System as well as through the federal Veterans Administration pension program. Veterans who need the aid and attendance of another individual may receive approximately $2400 a month to pay for their long-term care needs.

Connecticut and New York Offer Expanded Services

Connecticut and New York offer expanded services for individuals who need long-term care support at home, including those who do not meet the nursing home level of care (three ADL) criteria. The Connecticut Home Care Program for the Elderly has two separate programs. They evaluate the care needs for bathing, dressing, feeding, transferring (from a bed, a toilet) and overall safety risk. A safety risk can include risk of falling, wandering, leaving the stove on, or overdosing on medications. A person who needs assistance with two of the ADL or safety needs can functionally qualify for the lower-level program, which is solely funded by Connecticut. There is a 9% copay, but for many people who are in the early stages of dementia, that assistance may be just enough to keep the sick spouse safe and the healthy spouse sane.

The higher-level program is funded half by the state and half by the federal government through Medicaid. It can provide up to eight caretaker hours a day, and in some cases a live-in aide, as long as the caretaker can get up to five hours of uninterrupted sleep every day.

New York also has a two-tier system. Personal care and housekeeping services are available for individuals having difficulty with at least one or more activities of daily living. Those who meet long-term care criteria (requiring assistance with three or more ADLs) are entitled to receive all medical Medicaid services and personal care, as well as the following:

• Home delivered or congregate meals

• Housing improvements and moving assistance

• Medical social services, nutrition and dietary services

• Respite care, adult day care, and transportation

Long-Term Care Services in The Tristate

New York is known for offering relatively generous personal care and home health aide hours including, in some instances, live-in care, which is not covered in New Jersey.

Pennsylvania provides comprehensive long-term care services under Medicaid. There is no cap on services. However, the nursing home level of care must be met. Services that may be covered are broad, including personal care, non-medical transportation, home adaptation, meals delivery, etc.

New Jersey should look to its neighbors to consider areas for expansion of its MLTSS program if it really wants to meet the goal of assessing and meeting the needs of Medicaid beneficiaries receiving community-based services.