Assisted Living (AL)

What is AL?

AL is a Medicaid Waiver program that enables individuals, at risk of placement in a nursing facility and who meet income and resource requirements, to receive a broad array of supportive and health services by residing in an Assisted Living Facility.

What services may be provided?

AL offers all New Jersey Title XIX Medicaid services authorized in a Plan of Care (POC) except Nursing Facility, Adult Day Health Services, Personal Care Assistant and Medicaid Hospice services. All AL participants receive Care Management services. In addition the POC specifies other services to be delivered, which may include:

• Homemaker
• Chore
• Attendant Care
• Medication Administration
• Social Activities
• Skilled Nursing
• On-going Assessment
• Health Monitoring
• Transportation

Are there limits to AL services?

Enrollment in the AL Medicaid Waiver is available statewide to eligible New Jersey residents. The availability of AL services is determined by the number of vacancies in the provider facilities and the availability of Medicaid Waiver slots. Distribution of these slots is managed through the New Jersey Department of Health and Senior Services, Division of Aging and Community Services. The service package provided is based on an assessment of the individual’s needs, unique care plan, and availability of services and funding.

Who will provide these services?

Care Management: Qualified staff from the County Offices on Aging or their subcontractors provide Care Management.

Assisted Living: AL services are provided by Assisted Living Residences (ALR) and Comprehensive Personal Care Homes (CPCH) licensed by the New Jersey Department of Health and Senior Services, Division of Long Term Care Systems, according to N.J.A.C. 8:36. Each ALR and CPCH that accepts Medicaid reimbursement for participants is also enrolled as a Medicaid Provider. ALRs and CPCHs do not have to accept Medicaid participants.

• ALR refers to a facility housing four or more adults unrelated to the proprietor that provides apartment-style housing and congregate dining and assures that assisted living services are available when needed. Apartment units offer, at a minimum, one unfurnished room, a private bathroom, a kitchenette, and a lockable door on the unit entrance.
• CPCH refers to a facility housing four or more adults unrelated to the proprietor that provides room and board and assures that assisted living services are available when needed. CPCH units house up to two residents per room and have a lockable entrance door.

Who is eligible for AL Medicaid waiver services?

An AL Medicaid Waiver eligible individual is a New Jersey resident who:

Meets the following clinical requirements:

• Is at least 65 years old or 21 - 64 and determined disabled by the Social Security Administration or by the Disability Review Section of the Division of Medical Assistance and Health Services, New Jersey Department of Human Services; and
• Has been assessed by staff of the New Jersey Department of Health and Senior Services, Regional Office of Community Choice Options, and found to be in need of nursing facility level of care.

Meets financial eligibility by:

• Qualifying for Supplemental Security Income (SSI) in the community; or
• Qualifying for Institutional Medicaid:
  • Has a gross monthly income at or below $1,911 per month in 2008;
  • Resources at or below $2,000; or
• Qualifying for New Jersey Care:
  • Has a gross monthly income that is no more than 100% of the Federal Poverty Level ($867 in 2008)
  • Resources at or below $4,000.

A spouse's income is not considered in the determination of eligibility, but the spouse's resources are considered.

Is there a cost share in AL?

If applicable, AL program participants may pay the provider a cost share in addition to any room and board fees, depending upon his or her income and allowable deductions. The Care Manager calculates the cost share.

How do I apply for AL?

Individuals interested in receiving services through AL may contact the NJ EASE site in their county. NJ EASE is the Easy Access Single Entry point for senior service information, and can be reached toll free by dialing 1-877-222-3737. NJ EASE workers will assist callers and refer individuals to the proper application point.

For additional information contact:

New Jersey Department of Health and Senior Services
Division of Aging & Community Services
PO Box 807
Trenton, NJ 08625-0807
Phone: 1-800-792-8820

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