THE NEW JERSEY PERSONAL PREFERENCE PROGRAM (PPP)
by: Begley Law Group
By: Emily M. Schurr, Esquire and Thomas D. Begley, Jr., Esquire, CELA
The New Jersey Personal Preference Program (PPP) is a New Jersey Medicaid program that provides a much-needed service for individuals in need of home health aides. The program provides a monthly budget from Medicaid to employ parents, spouses, friends, relatives, or neighbors as the individual’s personal caregivers, instead of using a home health care agency. The budget is based on the number of authorized Personal Care Assistant (PCA) Services hours authorized multiplied by the current reimbursement rate, which is as much as $25 per hour in 2024. There are also fiscal management services to assist with paying care workers.
The program is designed to create autonomy and flexibility for individuals who need home health aides and have loved ones serving as caregivers.
ELIGIBILITY
To be eligible for the New Jersey Personal Preference Program, applicants must be eligible for NJ FamilyCare Plan A. Applicants must be approved for Personal Care Assistant Services and must need the Personal Care Assistant Services for at least six months. Lastly, applicants must be able to self-direct services (e.g., selecting their own caregiver, authorizing employee timesheets) or choose an “authorized representative” who can act on his/her behalf.
There are multiple categories of NJ FamilyCare Plan A eligibility. In 2024, children age 18 and under are eligible with incomes up to 355% Federal Poverty Level (FPL) ($9,230/month for a household of four). Adults (ages 19-64) are eligible with income up to 138% FPL ($1,732/month for a household of one, $2,351/month for a household of two, $3,588 for a household of four). Individuals eligible for Aged, Blind, Disabled Medicaid programs, including Medicaid Managed Long Term Supports and Services (MLTSS) are also eligible for NJ FamilyCare Plan A.
The person employed as the paid caregiver also has requirements to meet. The caregiver must be at least 18 years of age and authorized to work in the United States. The caregiver must be able to perform all care services and tasks required at the schedule requested by the individual with the disability.
♦Case Study. Wife is 45 years old and is a quadriplegic. Wife lives at home with Husband in New Jersey. Wife is mentally capable but struggles with some Activities of Daily Living (ADLs). Husband is her primary caregiver and wants to be paid by Medicaid for this role. Wife receives NJ FamilyCare Plan A and is “active” under one of the five NJ FamilyCare HMOs. Wife is eligible for Personal Care Assistant Services and will need these services for the foreseeable future (a period of more than six months). Wife can serve as her own “authorized representative” and self-direct these services, choosing to employ Husband as her paid caregiver. Husband can be employed through Medicaid as Wife’s paid caregiver.
STEPS TO APPLY
1.If you are receiving Medicaid but are NOT enrolled in Personal Care Assistant Services:
Go to your doctor and get a prescription requesting the Personal Care Assistant Services.
Call your Medicaid Managed Care Organization (MCO). Request a Personal Care Assistant Services assessment to be enrolled in the New Jersey Personal Preference Program.
A nurse will come to your home to assess eligibility for Personal Care Assistant Services and authorize hours per week based on level of need.
2. If you are receiving Medicaid and ARE already enrolled in the Personal Care Assistant Services:
Call your Medicaid Managed Care Organization. Tell them you want to switch from the Personal Care Assistant Services to the New Jersey Personal Preference Program.
A nurse may come to your home to reassess the number of authorized hours per week based on level of need.
3. After approved for the New Jersey Personal Preference Program:
Based on your level of need, a budget will be given.
You will select someone (other than your caregiver) to serve as the “authorized representative” who will be responsible for designating the paid caregiver and approving the employee timesheets. Alternatively, you can “self-direct” these services.
A financial consultant will come to your home to meet with you, your paid caregiver, and your authorized representative to discuss how to spend the budget to meet your care needs.
LIFE WHILE RECEIVING BENEFITS UNDER THE NEW JERSEY PERSONAL PREFERENCE PROGRAM
Your New Jersey Personal Preference Program monthly budget can be used for services such as: employment of individuals, including family members, to provide Personal Care Assistant Services; cleaning services from private companies; errand services to assist with banking, shopping, post office, and other routine tasks; laundry services; services from a home health agency; and supplies and equipment that promote or enhance independence that are not covered by Medicaid (e.g., small appliances, technology, etc.).
While enrolled in the New Jersey Personal Preference Program, your caregivers will be paid by Medicaid for the care they are providing for you. The program provides fiscal management services, through a service called PCG Public Partnerships, LLC (PPL), to assist with the financial aspects. PPL is responsible for handling payroll responsibilities, acting as a bookkeeping service, processing time sheets, and issuing paychecks to paid caregivers.
If you are capable of self-directing services, you can serve as your own “authorized representative”. The “authorized representative” must approve the employee timesheets. Upon submission of these timesheets online, the employee is paid. There will be periodic follow-up meetings throughout your enrollment in the program.
You can appeal if you are rejected or believe the number of authorized hours is inadequate. You may consider hiring a lifecare planner, social worker, or other advocate to assist in the appeals process. You can request a reassessment if there has been a change in circumstances.
The New Jersey Personal Preference Program is a Medicaid program separate from Supplemental Security Income (SSI) and Division of Developmental Disabilities (DDD) and does not affect your eligibility for these programs.
A NOTE ON GUARDIANSHIP AND THE NEW JERSEY PERSONAL PREFERENCE PROGRAM
If an individual has been deemed incapacitated and has a guardian, there is an additional consideration. Parents often serve as guardians of their adult children with severe disabilities. If the child lives in the home with the parent/guardian, the parent may want to be employed by the New Jersey Personal Preference Program as the paid caregiver. The New Jersey Personal Preference Program can employ a guardian as the paid caregiver without issue. However, there must be a separate individual serving as the “authorized representative” for the New Jersey Personal Preference Program. The guardian cannot serve as both the paid caregiver and authorized representative, and the incapacitated individual cannot serve as his/her own authorized representative due to incapacity. Therefore, a third individual must be involved.
♦Case Study. Son is 30 years old, has Autism, and lives at home in New Jersey with Mom. Son has been deemed incapacitated and Mom has been appointed as Guardian of Son. Mom is Son’s primary caretaker. Brother is 35 years old, also lives in New Jersey, and is close with Mom and Son. Brother is well aware of the family situation and what Son needs to thrive. Son receives NJ FamilyCare Plan A and is “active” under one of the five NJ FamilyCare HMOs. Son is eligible for Personal Care Assistant Services and will need these services for a period of more than six months since this is not a short-term disability. Because Mom is Son’s primary caretaker, she would like to get paid by Medicaid for this role. However, she cannot serve as both Son’s caregiver and his “authorized representative” to handle the fiscal management aspect of the New Jersey Personal Preference Program. Son cannot serve as his own “authorized representative” due to the nature of his particular disability. Brother can serve as Son’s authorized representative to act on Son’s behalf, appoint Mom as a paid caregiver, and handle fiscal management and payroll. Mom can serve as both Son’s guardian and paid caregiver.
ADDITIONAL RESOURCES
https://www.nj.gov/humanservices/dmahs/clients/njppp.html
https://www.state.nj.us/humanservices/dmahs/clients/ PPP_Fact_Sheet.pdf
The New Jersey Personal Preference Program Helpline Number: 609-631-2481
The New Jersey Personal Preference Program statute: NJAC § 10:142