THE PERSONAL INJURY ATTORNEY’S GUIDE TO MEDICAID

by Thomas D. Begley, Jr., Esquire, CELA

 

           There are many pathways to Medicaid in New Jersey.  Each one has different income requirements and resource limits, some have transfer of asset penalties, some require disability, and some require that a personal injury settlement be placed in a Special Needs Trust to maintain eligibility while others do not.  This article will briefly discuss seven of the most commonly-used Medicaid programs in New Jersey.

 

• Supplemental Security Income (SSI) Linked Medicaid. SSI is a monthly income to the beneficiary.  The maximum federal monthly income limit for 2021 is $794.  In addition, there is a State supplement of $31.25.  In New Jersey the individual receiving SSI automatically receives Medicaid.  Conversely, if an SSI recipient loses SSI, he or she also loses the SSI-linked Medicaid.  There is a resource limit of $2,000.  There is a transfer of asset penalty calculated by dividing the amount transferred by the maximum federal benefit with a maximum penalty of the three years.  An individual must be determined to be disabled by the Social Security Administration to qualify for SSI.  In order to maintain this benefit, a Special Needs Trust would be required for the net personal injury settlement.

 

• New Jersey Family Care. The basic New Jersey Family Care program is based on income.  For a single individual the income limit is $1,468 as of March 1, 2020.  The 2021 income limits have not been published.  The income limit increases based on family size.  There is no resource limit or transfer of asset penalty.  Disability is not required, and if the individual receives a personal injury settlement.  The age limit for New Jersey Family Care is 64.  A Special Needs Trust would not be required.

 

• New Jersey Workability. New Jersey Workability is a program designed to encourage individuals to work by permitting them to maintain Medicaid under certain conditions.  A single individual on New Jersey Workability in 2020 is entitled to earned income of $5,383 and unearned income of $1,064.  A married individual on New Jersey Workability in 2020 is entitled to earned income of $7,249 and unearned income of $1,437.  The resource limit for a single individual is $20,000, and for married the resource limit is $30,000.  There is a transfer of asset penalty.   The Disability Determination must be obtained, and a Special Needs Trust would be required if the personal injury settlement resulted in the personal injury victim being placed over the resource limit.  The age range is 16 to 64.  The 2021 financial eligibility limits have not yet been published.

 

• Managed Long-Term Services and Supports (MLTSS). This is a program providing medical support for individuals receiving home care, assisted living or home care.  The income limit for 2021 is $2,382.  The resource limit is $2,000.  There is a transfer of asset penalty.  Disability is required, and if a personal injury recovery is obtained a Special Needs Trust would be required to maintain eligibility.

 

• Children’s Health Insurance Program (CHIP). This is part of New Jersey Family Care.  CHIP is medical insurance program for children under age 19.  The income limit is 350% of the federal poverty level or $3,775 for a single child, which is considerably higher than the income eligibility limit for most Medicaid programs.  There is no asset limit for CHIP.  There is no transfer of asset penalty.  Disability is not required, and if a CHIP recipient is receiving a personal injury settlement no Special Needs Trust is required.  However, unless the CHIP recipient is over age 18, a Settlement Protection Trust may be advisable.  Even if a personal injury victim is over 18, a Settlement Protection Trust should be considered.

 

• Medicaid for Aged, Blind and Disabled Persons. This is a medical insurance program for single persons and married couples.  The income limit in 2020 for a single person is $1,063 per month, and for a married couple $1,437 per month.  The resource limit for a single person is $4,000, and for a married couple is $6,000.  There is a Medicaid transfer of asset penalty.  To be eligible an applicant must be over age 65 or must be determined to be blind or disabled by the Social Security Administration or the State Medicaid Agency.  If the personal injury victim is receiving a recovery a Special Needs Trust would be required to maintain eligibility.  Financial eligibility requirements for 2021 have not yet been published.

 

• Pregnant Women. This is a program under New Jersey Family Care.  It provides Medicaid to pregnant women who are residents of New Jersey and either U.S. citizens or immigrants whose documentation allows them to reside permanently in the U.S.  Family income must be at or below 205% of the federal poverty level (FPL).  Coverage extends to women during pregnancy and for 60 days following delivery or the date on which the pregnancy ends.  A child born to an eligible New Jersey Family Care mother is eligible for Medicaid for one year, regardless of changes in the family’s income.  No Special Needs Trust is required for a personal injury recovery.