Special Medicaid Programs

Family Care

NJ Family Care is a federal and state funded health insurance program created to help New Jersey’s uninsured children and certain low-income parents and guardians to have affordable health coverage. NJ Family Care is for families who do not have available or affordable employer insurance, and cannot pay the high cost of private health insurance.

Medically Needy Program

The Medically Needy Program provides specific medical benefits to needy New Jersey residents who may not be able to afford health care services but have income and/or assets that are too high to qualify for Medicaid. Individuals must be 65 years old or older, blind or disabled, pregnant, or a needy child under 21 years of age. This is the only program which contains a “spend down” component, that is, an applicant who is not immediately income eligible may become eligible after spending a certain amount of income on approved medical bills.

Medicaid in the Community

This program provides full Medicaid coverage to individuals residing in the community who are 65 years of age or older, blind or permanently and totally disabled, and whose income and resources do not exceed the Supplemental Security Income (SSI) standards, but who do not qualify for SSI for other reasons.

Long-Term Care Medicaid

Medicaid coverage provided to eligible individuals in a participating hospital or Long Term Care Facility (Nursing Home). The hospitalization or placement must be of at least 30 days duration and medical need must be approved by the Medicaid District Office prior to placement.

Community Care Program for the Elderly & Disabled – CCPED

A program especially designed to help individuals return to the community from a nursing home or to help individuals remain in the community rather than be admitted to a nursing home. An individual plan of care is developed by a case manager to assure quality care in a cost-effective manner. The program does not provide regular Medicaid coverage (doctor, hospital, prescriptions, etc.) and assumes that the applicant has Medicare and/or other health insurance. It does provide payment for such services as Home Health Services, Homemaker Services, Medical Day Care, Medical Transportation, Respite Care and Social Adult Day Care. The eligibility requirements are essentially the same as for Long Term Care (Nursing Home) Medicaid.

Home Care Model Waiver I, II & III

Home Care Waiver I, II, and III are special programs with a maximum of 50 slots each statewide, established to enable individuals with long-term care needs to remain in the community rather than be cared for in a hospital or nursing home. The individual must be a blind or disabled child or adult requiring at least an Intermediate Care Facility level of care and having income and resources below the Long Term Care amount. The program provides full Medicaid coverage. In addition, case management services are provided to the individual to aid in planning, locating, coordinating and monitoring services selected to meet the individual’s health needs.

The waiver III program is essentially the same as Waiver I & II, except that applicants must require a skilled nursing facility level of care and the services of a private-duty nurse. The program provides full Medicaid coverage plus private-duty nursing up to 16 hours per day. Nursing home placement is not covered. Administration is as described above.

AIDS Community Care Alternatives Program – ACCAP

A Medicaid Waiver program which allows individuals diagnosed as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) to receive extensive care in the community. It provides full Medicaid coverage including private-duty nursing, narcotic and abuse treatments at home and personal care assistant services. Eligibility requirements are essentially the same as those for Long Term Care (Nursing Home) Medicaid.

Hospice Program

This a program of palliative services provided to the terminally ill in their own home, a nursing facility or a state approved hospice. Services, including respite care to relieve the caregiver, are provided if the applicant meets the SSI, NJC or Medicaid CAP financial standards.

Traumatic Brain Injury Program

The Traumatic Brain Injury Program is a Federal program which offers home and community-based services to persons disabled by a traumatic brain injury. The purpose of the program is to help individuals remain in, or return to the community rather than placed in a nursing facility.

Medical Transportation

The Medical Transportation Program provides recipients eligible under Medicaid, Welfare, Medically Needy, and SSI programs with transportation to hospitals, and to the offices of physicians, dentists, ophthalmologists, and optometrists. Additionally, dialysis patients who are eligible under Title XIX and Title XX funding are provided with transportation to hospitals and dialysis centers for their treatment. Transportation is also provided to patients who range from the ambulatory to those who are disabled or confined to wheelchairs and must be assisted in and out of their homes in order to utilize the program.