by: Begley Law Group

by Thomas D. Begley, Jr., Esquire, CELA and Emily Schurr

            New Jersey has over 30 Medicaid programs of which personal injury victims may avail themselves.  This article will discuss benefits received from these programs.  Many personal injury victims are not currently receiving public benefits, including Medicaid, but are eligible to do so.  An analysis should be made of the potential benefits that are available and whether or not the personal injury victim is receiving those benefits or could be receiving those benefits with proper planning.  Finally, an analysis must be made as to whether a Special Needs Trust is required to maintain or obtain Medicaid eligibility.  The eligibility requirements for many Medicaid programs do not require a Special Needs Trust.  It all depends on the program.


            Many Medicaid programs include a broad range of benefits, including doctors and hospitals.  Most programs do not include assistance with home care, assisted living, or nursing home care.

  • SSI-Linked Medicaid. Individuals receiving Supplemental Security Income (SSI) automatically receive Medicaid linked to SSI, but this Medicaid program does not include payment for home care, assisted living, or nursing home care.
  • Medicaid programs under Managed Long Term Care Services and Supports (MLTSS) include home care, assisted living, and nursing home care.
  • New Jersey FamilyCare. NJ FamilyCare is a Medicaid program that exists under a Section 1115 Waiver Program from the federal government.  Programs include:
    • Obamacare. Obamacare is a very common form of Medicaid that includes medical benefits for individuals aged 19 to 64.
    • Children’s Health Insurance Program (CHIP). CHIP provides a portion of medical benefits for children under age 19, under the umbrella of NJ FamilyCare.
    • Pregnant Women. NJ FamilyCare extends to pregnant women, including up to sixty days following delivery, and to children less than one year old.
    • Plan First Program. The Plan First Program is a family planning service limited to birth control, family planning counseling, pregnancy tests, tubal ligation, and vasectomies.  Recipients cannot be pregnant or sterile to receive this benefit.
    • NJ Supplemental Prenatal and Contraceptive Program (NJSPCP). This program includes prenatal care and family planning services for undocumented women, but does not include full healthcare coverage.
    • Aged, Blind, Disabled (ABD). Medical benefits are also available under NJ FamilyCare through the Aged, Blind, Disabled (ABD) Program.  Individuals must be over age 65 or any age if they are deemed blind or disabled.
    • Personal Care Assistant (PCA) Services. Medicaid provides caseworkers from a Medicaid Agency to assist with activities of daily living (ADLs) (e., bathing, dressing, feeding, toileting, and transferring); and instrumental activities of daily living (IADLs) (i.e., preparing and serving meals, relearning household skills, assistance at doctors’ appointments, and other household duties).  Eligible individuals must live in a community-based residence, including a private home, where personal care is not provided.
    • Personal Preference Program (PPP). Under the New Jersey Personal Preference Program, an individual is given a monthly budget to self-direct personal care assistant (PCA) services by employing spouses, parents, friends, or relatives to provide care.  An assessment is made by a Managed Care Organization (MCO) to determine the hours needed.  Caregivers are paid up to $23 per hour for providing the necessary care.  An advantage of this program is that it is self-directed and does not require the use of a Medicaid Home Health Agency.
  • New Jersey WorkAbility. Under certain circumstances, an individual aged 16 to 64 with a disability may work and still receive Medicaid benefits.
  • Division of Developmental Disabilities (DDD). The Division of Developmental Disabilities offers two significant programs: the Supports Program (SP) and the Community Care Program (CCP).  The purpose of these programs is to provide services to avoid institutionalization and to return to community living.
  • Traumatic Brain Injury (TBI) Fund. This program directly purchases supports and services related to a brain injury, including home modifications, therapies, service coordination, assistive technology, and personal care.
  • Mental Health and Psychiatric Facilities. NJ FamilyCare covers mental health, behavioral health, and substance abuse services.  Treatments include intensive outpatient treatment, partial hospitalization, residential treatment, and inpatient psychiatric treatment.  Certified Community Behavior Health Centers and Psychiatric Residential Treatment Facilities (non-hospital facilities) are included.
  • Childcare Assistance Program. This program covers a portion of childcare services.  There is a maximum subsidy based on income and family size, age of the child in care, type of care selected, and hours of care needed.
  • Adoption Subsidy. Under the Adoption Subsidy Program, payments are made to adoptive parents for the care, maintenance, and education of a child with special needs.  The child must have special needs that might make the child hard to place (g., child is 10+ years old or has a serious medical condition or developmental disability).  The child will also be eligible for Medicaid.
  • Aid to Family with Dependent Children (AFDC)-Related Medicaid. This includes Medicaid benefits.
  • Prescription Drug Programs. New Jersey has two prescription drug discount programs.  Pharmaceutical Assistance to the Aged and Disabled (PAAD) is available to pay for prescriptions for individuals aged 65 or older or aged 18 to 64 receiving SSDI.  PAAD has a $5 copayment for generic drugs and a $7 copayment for brand name drugs.  Senior Gold is available for certain individuals who are ineligible for PAAD and it covers up to 50% of out-of-pocket drug costs after a $15 copayment.
  • Jersey Assistance for Community Caregiving (JACC). This program provides community-based services for individuals aged 60 or older.  JACC participants receive care management services, adult day health services, chore services, home modifications, home care services, home delivered meal service, personal emergency response system, respite care, social adult day care, specialized medical equipment and supplies, and transportation services.
  • Charity Care. New Jersey has a hospital care payment assistance program that provides free or reduced charges for individuals who receive inpatient and outpatient services at acute care hospitals.
  • Alzheimer’s Adult Day Services Program (AADSP). Adult day care services are available up to 5 days per week for individuals with Alzheimer’s or related dementia, such as Huntington’s or Parkinson’s.  The subsidy ranges from 20% to 100% of the cost of services.  Services include at least 5 hours per day at an adult day care center, at least one full meal, transportation, support to families, and special training for staff on managing dementia.
  • Statewide Respite Care Program (SRCP). This program provides services to give a caregiver a short-term or periodic break.  This benefit allows a caregiver to take a vacation, receive surgery, take care of himself/herself, run errands, etc.
  • This is a transportation service that provides non-emergency medical transportation for NJ FamilyCare recipients.
  • New Jersey Medicare Savings Programs (MSP). This is a program for New Jersey residents on Medicare who have limited income and resources, whereby Medicaid pays all or a portion of the Medicare Part A and Part B premiums and certain deductibles, coinsurance, and copayments for services and items Medicare covers.

Future articles will discuss the eligibility requirements for these various programs, including income limits, resource limits, transfer of asset penalties, lookback periods, medical requirements, and whether a Special Needs Trust is required.