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Medicaid Crisis Planning

Serving Clients in River Edge and Surrounding Areas


Do you have the resources necessary for covering medical expenses incurred by a serious accident? Will your insurance pay for long-term care in a nursing home if a loved one develops a chronic and debilitating illness?

Finding affordable care when the unexpected happens is stressful and frightening. Local health departments try to help, but often lack the manpower and resources to follow through with assistance services.

If you are caught in this type of situation, please contact the River Edge, NJ law office of Giro & Associates for immediate help with determining the best options for long-term care. You can see how your loved one may qualify for financial support from different Medicaid programs.

How Expensive is Long-term Medical Care in the U.S.?

Recent information about the cost of long-term healthcare in New Jersey comes from Genworth's Cost of Care Survey (2021):

  • Monthlycost of a home health aide--$5,710
  • Monthly cost of adult day care for one individual--$1,950
  • Monthly cost for one individual to stay in an assisted living facility--$6,495
  • Monthly cost for one individual to stay in a nursing home facility (semi-private room)--$11,254
  • Monthly cost for one individual to stay in a nursing home facility (private room)--$12,151

The median yearly cost of private nursing home rooms in the U.S. is about $106,000, with annual increases near four percent. Where can a person with a low income and limited resources find the means to pay for such a high cost in long-term medical care?

Crisis Planning With Medicaid

Medicaid is a federally supported health insurance program for low-income individuals of all ages. The U.S. Department of Health and Human Services leaves it up to each state to determine eligibility guidelines for Medicaid.

Eligibility requirements for Medicaid in New Jersey include:

  • Being aged 65 or older
  • Having a disability confirmed by the Division of Medical Assistance and Health Services or the U.S. Social Security Administration
  • Being a U.S. citizen and resident of New Jersey

New Jersey also has a program called Community Medicaid. Individuals eligible for Community Medicaid must have a gross monthly income of less than $903 per month. Money coming from Social Security payments, pensions, annuities, veteran's benefits, rental income, and trust fund payments are all considered as income.

The maximum amount of resources a New Jersey resident can have for Medicaid eligibility is currently $4000. Countable resources are bank accounts, stocks and bonds, annuities, CDs, and real estate other than the primary residence.

Eligibility for Institutional Benefits Through Medicaid in New Jersey

In addition to meeting financial requirements, individuals applying for Medicaid-provided institutional benefits must meet medical requirements. In most cases, if a person requires long-term care in a nursing home or assisted care facility, they are suffering from a disability that prevents them from completing activities of daily living (ADLs) without assistance.

Individuals requiring long-term, institutionalized care in New Jersey cannot exceed the Medicaid income cap currently set at $2022. However, the amount of a person's income is always applied to the cost of institutionalized care. For example, if a 70-year-old with late-stage Alzheimer's disease is receiving $1500 in Social Security retirement benefits, the state uses that money to first pay for the person's medical care. The remaining unpaid costs are then paid for by Medicaid.

Supplemental Security Income (SSI) and Medicaid in New Jersey

New Jersey residents who are determined for SSI eligibility are also eligible for full Medicaid benefits. SSI eligibility requires an individual to have a monthly income of no more than $705.25 and no more than $2000 in resources. A single person who must enter a long-term health care facility has to liquidate their resources to help defray costs. SSI payments are also used first before Medicaid starts paying that person's long-term medical expenses.

This oversimplified explanation of Medicaid rules and regulations does not even begin to decipher the complexities of applying for, and getting approved for, Medicaid. Many people apply online and get turned down for making one error on one form. Others may not have a good understanding of what constitutes income or assets (resources). There is also the risk that Medicaid views an honest mistake as a deliberate mistake.

Let the experienced attorneys at Giro & Associates remove the stress and aggravation of applying for Medicaid in New Jersey by guiding you through the process. Our legal team also offers competent advice throughout the application procedure, ensuring that you keep as much of your total assets and income as allowed by the state of New Jersey's Medicaid program.

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Giro & Associates, LLC

1060 Main Street, Ste. 303
River Edge, NJ, 07661

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