My Patient Guide
Guiding you every step of the way.
General Health and Medical
o Pharmaceutical Assistance To the Aged and Disabled Program (PAAD)
o Senior Gold Prescription Discount Program (SENIOR GOLD)
o Hearing Aid Assistance to the Aged & Disabled (HAAAD) Program
o New Jersey Care (Includes Qualified Medicare Beneficiary (QMB)
o Specified Low-Income Medicare Beneficiary Program (SLMB)
o Medically Needy Program
o Adult Family Care Program (AL/AFC)
o Global Options (GO) Nursing Facility Transition (NFT)
o Community Care Program for the Elderly and Disabled (CCPED)
o Assisted Living Waiver
o Jersey Assistance for Community Caregiving (JACC)
o ECO Waiver
o Personal Assistance Services Program
o Respite Care Program
o Adult Day Care for Alzheimer's Victims
o Community Choice Initiative
o Long-Term Care Facilities
o Hospital Respite Care Programs for Senior Citizens
o Boarding Homes/Residential Health Care Facilities
o Selection/Evaluation
o Pre-Admission Screening Program
o Nursing Home Services
o "Medicaid" Beds
General Programs
New Jersey has a number of programs designed to assist eligible residents in receiving needed medical care and services. There are varied income and asset limits for most of these programs. A description of these programs follows. Generally speaking, these programs are administered by the Division of Aging and Community Services, NJ Department of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807.
Pharmaceutical Assistance to the Aged and Disabled (PAAD)
You are eligible to participate in the Pharmaceutical Assistance to the Aged and Disabled Program (PAAD) if you meet the following requirements:
* You are 65 years of age or older, OR, at least 18 years of age and receiving Social Security disability benefits;
* You are single, and meet the annually established income requirements OR, you are married or a civil union couple, and your joint annual income meets the annually established income limits. All sources of income, including Social Security and Medicare Part B premiums, if paid, are counted as income. NOTE: The annual income eligibility limits are increased by the amount of the maximum Social Security benefit cost-of-living increase for that year.
* You have been a NJ resident at a permanent address for at least 30 days before applying and your residence is not seasonal or temporary but a legally established residence;
* You do not have equal or superior prescription coverage through another source. If you have only partial or limited coverage, you are eligible.
* You enroll in a Medicare Part D Prescription Drug Plan.
To apply, a PAAD application form must be completed. Application forms can be found at senior citizen centers, Medicaid offices, local pharmacies or the Area Agencies on Aging. A husband and wife must file separate applications.
A new federal program offering prescription drug coverage for Medicare beneficiaries began on January 1, 2006. This coverage is provided through private companies whose plans are approved by Medicare. All PAAD beneficiaries enrolled in Medicare Part B must join a Medicare prescription drug plan. If you choose a Medicare Part D Prescription Drug Plan that is at or below the average cost, you will NOT have to pay premiums, deductibles, or any out-of-pocket costs. With the PAAD card, participants must pay $5.00 for each prescribed drug and the State pays the remainder. Only drugs approved by the U.S. Food and Drug Administration are covered. Drugs purchased outside the State of NJ are not covered, nor any pharmaceutical products whose manufacturer has not agreed to provide rebates to the State of New Jersey.
PAAD allows up to a 34-day supply or 100 doses whichever is greater of a drug when this amount is medically necessary and prescribed by your physician.
For the annual income limits or additional information, please contact the PAAD Program, Division of Senior Benefits and Utilization Management, NJ Department of Health & Senior Services, PO Box 715, Trenton, NJ 08625-0715, telephone, toll-free, 1-800-792-9745 or 609-588-7048.
Senior Gold Prescription Discount Program (SENIOR GOLD)
The State of New Jersey offers a prescription discount program, SENIOR GOLD. The Senior Gold Prescription Discount Plan makes available prescription coverage to residents who are ineligible for the Pharmaceutical Assistance for the Aged and Disabled program (PAAD). The Senior Gold beneficiary pays $15 plus 50% of the remaining cost of the drug. Senior Gold participants (single, married or civil union couples) with out-of-pocket prescription costs exceeding the set annual limits will have 100% of their prescription costs paid after paying the $15 co-payment per prescription.
A new federal program offering prescription drug coverage for Medicare beneficiaries began on January 1, 2006. This coverage is provided through private companies whose plans are approved by Medicare. The Medicare prescription drug coverage may save you money on your prescriptions if your current prescription costs are more that $50 a month or if your drug need or cost increases in the future. If you choose Medicare prescription drug coverage, you MUST pay the premiums and Senior Gold will help you pay for any other out-of-pocket costs.
You are eligible to participate in the Senior Gold Prescription Discount Program if you meet the following requirements:
* You are a New Jersey resident.
* Your annual income meets the annually established income requirements.
* You are age 65 or older or receiving Social Security Disability Benefits.
Along with your completed SENIOR GOLD application, you must submit:
* Proof of New Jersey residency.
* Documentation indicating you are over the age of 65 or receiving Social Security Disability.
* A copy of you health insurance card.
* A signed copy of your most recent income tax return.
* A copy of your Medicare card.
Applications are available from Senior Gold, local pharmacies, senior centers or the County Office on Aging. For the annual income limits or additional information, please contact the SENIOR GOLD Prescription Program, Division of Senior Benefits and Utilization Management, NJ Department of Heath & Senior Services, PO Box 724, Trenton, NJ 08625-0724, telephone toll-free 1-800-792-9745 or 609-588-7048.
Hearing Aid Assistance to the Aged & Disabled (HAAAD)
The State of New Jersey offers hearing aid assistance for persons not otherwise qualified for Medicaid who meet the age/disability, income and residency requirements of the Pharmaceutical Assistance to the Aged and Disabled Program (PAAD). A person eligible for assistance under the Hearing Aid Assistance to the Aged & Disabled program (HAAAD) is entitled to receive up to $100.00 toward the purchase of a hearing aid.
For further information, please contact the PAAD-HAAAD Program, Division of Senior Benefits and Utilization Management, NJ Department of Health & Senior Services, PO Box 715, Trenton, NJ 08625-0715, telephone, toll-free, 1-800-792-9745 or 609-588-7030.
New Jersey Care . . . Special Medicaid Program
(Includes Qualified Medicare Beneficiary (QMB))
New Jersey Care
provides full Medicaid coverage to NJ residents who are 65 or older, or blind, or permanently disabled as defined by the Social Security Administration, and who meet specified income and asset guidelines. If you are eligible, New Jersey Care will also pick up the cost of your monthly Medicare Part B premium, as well as your Medicare Part A premium, if you are required to pay for it. Certain unearned income may be disregarded. For those enrolled in Medicare Part B, the monthly premium is considered income and must be included in determining eligibility. Regulations regarding resources and spousal impoverishment provisions of the Medicare Catastrophic Coverage Act of 1988 are equally applicable.
For further information, please contact your County Board of Social Services/County Welfare Board or call 1-800-356-1561.
Specified Low-Income Medicare Beneficiary (SLMB) Program
NOTE: The federal Specified Low-Income Medicare Beneficiary (SLMB) Program, which pays for the Medicare Part B premium only, has slightly higher income guidelines but the same asset guidelines as the New Jersey Care program. If you do not qualify for the New Jersey Care program, but would like to find out if your qualify for the SLMB program, please contact the New Jersey Department of Health and Senior Services at 1-800-792-9745 or 609-588-7047.
Medically Needy Program
New Jersey's Medically Needy Program is designed to assist certain NJ residents, not eligible for Medicaid, to receive medical care and services. Among those eligible for consideration are persons 65 and older, or blind, or disabled as defined by the Social Security Administration. Also included is long-term care and related pharmacy services for eligible individuals residing in Medicaid participating nursing facilities. The program is designed for eligible persons with excessive medical bills, which cause the income to be "spent down" to current Medicaid eligibility income. The Medically Needy Program offers basically the same services as Medicaid.
The Medically Needy Program is administered by the Division of Medical Assistance & Health Services, NJ Department of Human Services. To find out if you qualify for the program, or for more information, contact your County Board of Social Services/County Welfare Agency or call 1-800-356-1561.
Adult Family Care
Adult Family Care is a community-based contractual arrangement where up to three persons receive room, board, personal care, and other supportive health and social services in the home of an unrelated individual who has been approved by a Sponsor Agency and trained to provide the necessary care. Services are provided according to instructions on an individualized client service plan based on an assessment of the client's need for services. The cost of Adult Family Care includes a fee for room and board, services, and an operational cost for the Sponsor Agency.
Eligibility criteria for individuals include:
* New Jersey resident 18 years or older
* Frail, elderly, or physically disabled
* Has a medical condition or requires a regimen of therapy that can be adequately provided by the caregiver in the home
* Is not a danger to self or others
* Agrees to comply with the written agreement regarding client's responsibilities and financial obligations. NOTE: The Adult Family Care (Al/AFC) and the Assisted Living Waiver pays for care in a variety of settings for the elderly and disabled.
Inquiries can be directed to the NJ Department of Health and Senior Services, Division of Aging and Community Services, 609-943-4060 or contact your County Board of Social Services/County Welfare Agency.
Global Options (GO) Nursing Facility Transition (NFT)
Global Options (GO) Nursing Facility Transition (NFT) is a long-term care initiative that allows certain nursing facility residents to receive supportive services that enables them to return to the community. Funds from home and community based services and institutionally based care are equitably distributed to allow individuals to select a variety of support services for the provision of a comprehensive plan of care for the individual in a setting of their choice. Individuals must be able to direct one’s own care.
Support services for GO NFT participants can be provided by community agencies or qualified Participant Employed Providers that can include family members, friends, or neighbors. All providers must meet qualification requirements which have been approved by the federal government.
Eligibility requirements are:
* An Individual who is clinically and financially approved for nursing home level of care through Medicaid;
* A resident in a nursing facility;
* Assessed by a State Community Choice Counselor for transition back to the community;
* Planned discharge has been coordinated through the Interdisciplinary Team.
Individuals interested in receiving service through Global Options (GO) Nursing Facility Transition (NFT) may contact NJ EASE at 1-877-222-3737. For additional information please contact the NJ Department of Health and Senior Services, Division of Aging and Community Services, telephone, toll-free, 1-877-856-0877.
Community Care Program for the Elderly and Disabled (CCPED)
The Community Care Program for the Elderly & Disabled is a special Medicaid waiver program offering a variety of community-based services to help eligible individuals remain in or return to the community rather than be cared for in a nursing facility.
You may be eligible if you meet the following standards:
* You are not already receiving Medicaid services in the community;
* You are age 65 or older, OR you are eligible for Social Security disability;
* Your medical needs meet the criteria established by the NJ Medicaid program;
* Your income and assets meet the financial guidelines of the program.
(NOTE: Your monthly income cannot be higher than the institutional Medicaid cap. Depending on your income, you may be asked to share in the cost of the program.)
Inquiries can be directed to the Division of Aging and Community Services, NJ Department of Health and Senior Services, 609-943-4060 or contact your County Board of Social Services/County Welfare Agency.
Jersey Assistance for Community Caregiving (JACC)
Jersey Assistance for Community Caregiving provides a broad array of in-home services and supports that enable an individual at risk of placement in a nursing facility to remain at home. JACC is a cost-sharing program intended to supplement and strengthen the capacity of caregivers as well as delay/prevent placement in a nursing facility.
Eligibility requirements for JACC:
* Is 60 years of age or older
* Resides in a home which is he/she owns, rents, or is the home of a relative that is not licensed
* Is financially ineligible for Medicaid or Medicaid waiver services
* Has countable resources at or below the established amount
* Has no alternate means available to secure needed services and/or supports
* Has been determined to be clinically eligible for nursing facility level of care
* Is a United States Citizen or a Qualified Alien
* Has income that is a cost sharing of less than 100% of service costs.
Inquiries can be directed to the Division of Aging and Community Services, NJ Department of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807, 609-943-4060 or through NJEASE 1-877-222-3737.
Enhanced Community Options Waiver (ECO)
Enhanced Community Options (ECO) is a Medicaid Waiver that offers several care alternatives to individuals who would otherwise be at risk of placement in a nursing facility. ECO increases the type and amount of options for community care available to those individuals who have been determined to require a nursing facility level of care. The ECO waiver provides the opportunity to receive services in the community setting of one's choice. ECO includes the residential components, Assisted Living and Adult Family Care (AL/AFC), as well as an In-Home Service component, known as the Caregiver Assistance Program (CAP).
For information contact the New Jersey Department of Health and Senior Services, Division of Aging and Community Services, Office of Home and Community Services, PO Box 807, Trenton, NJ 08625-0722, Telephone 609-943-4060 or 1-877-222-3737.
Personal Assistance Services Program
The Personal Assistance Services Program is designed to provide assistance to physically disabled NJ residents age 18 to 65 to enable them to live independently and participate in community-based activities. Through this program, participants will be provided with up to 40 hours per week of personal services to assist them in the performance of routine, nonmedical tasks, that are directly related to maintaining their health and independence in order to enable them to be employed or receive training or education related to employment, or to support community-based independent living. Depending on family income, some individuals pay no fee. Others pay a portion of the cost on a sliding fee scale, based on their income.
For the provider agency in your county, persons 60 to 65 should contact their Area Agency on Aging. All others should contact the State Division of Disability Services, NJ Department of Human Services, PO Box 700, Trenton, NJ 08625-0700, telephone, toll-free 1-888-285-3036 or 609-292-7800.
Respite Care Program
The State of New Jersey offers a Statewide Respite Care Program to provide respite services to families and other uncompensated caregivers experiencing fatigue and stress due to long-term caregiving of frail elderly and/or functionally impaired persons 18 years of age or older. Through these services, caregivers are given relief from the physical and emotional demands of caregiving. The services provided are temporary, short-term and intermittent in nature. They include:
* Companion
* Homemaker/Home Health Aide
* Medical adult day care
* Social adult day care
* Short-term in-patient care in a licensed medical facility
Priority is given to those families where the impaired member is at risk of long-term care institutionalization due to inability of a caregiver to continue in that role. The individual requiring care is the only one whose income is considered when establishing eligibility for participation in this program. While the NJ Department of Health and Senior Services provides overall administration of the program, a sponsor agency in each county administers the program locally.
For further information regarding the location of the sponsoring agency in your county, please contact your Area Agency on Aging toll-free at 1-877-222-3737.
Adult Day Care for Alzheimer's Victims
The State of New Jersey, through its Adult Day Care for Alzheimer's disease and Related Disorders Program, provides for specialized programs statewide that serve victims of chronic progressive dementing diseases and their caregivers. The State pays the participating day care center 75 percent of the daily cost of adult day care and the remaining 25 percent that the State does not pay comes from participant co-payments or other sources as determined by the participating day care center. Persons eligible for this program are those who are:
* Diagnosed by a licensed physician as having Alzheimer's Disease or a related disorder including -- multi-infarct dementias, Parkinson's Disease with dementia, Huntington's Disease, Cruetzfeldt-Jacobs Disease, or Pick's Disease;
* Cared for/supervised by a family member or other informal caregiver;
* Residing in the community, but who are not residents of a rooming/boarding home;
* Determined income eligible.
Programs and services offered under this Adult Day Care Program include: (a) health monitoring, (b) counseling, 8 recreation, (d) socialization, (e) nutritional meals, (f) caregiver education, (g) support groups, (h) information and referrals.
For information on whether this program is available in your community, please contact your Area Agency on Aging. This program is administered by the Department of Health and Senior Services, Division of Aging and Community Services, PO Box 807, Trenton, NJ 08625-0807, telephone 1-800-792-8820 or 609-943-3475. For information about Medical and Social Day Care Programs please call the Area Agency on Aging or 609-633-9042.
Community Choice Initiative
The statewide Community Choice Initiative is designed to select short term Medicaid Nursing Facility residents and provide them with choices on community based alternatives to residing in a nursing facility. The resident's discharge is coordinated with other state and community agencies and necessary support services are provided to help make the transition from a nursing facility to community housing. Through this program Counselors:
* Provide information on special housing, community programs and in-home services
* Explain any financial or medical requirements
* Coordinate with your discharge planner to find services that support dignity, choice and independence
* Help you and your family make arrangements so that you will be happy, safe and cared for in an appropriate community setting.
Please contact the Division of Aging and Community Services, Department of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807, telephone, toll-free, 1-877-856-0877 or 609-943-5248.
Institutional
Long-term Care Facilities - Persons in long-term care facilities who are Medicaid eligible are entitled to receive a monthly Personal Needs Allowance. Beneficiaries with Veterans Administration Improved Pensions may receive slightly higher amounts.
For information please contact your County Board of Social Services/ Welfare Agency.
Hospital Respite Care Programs for Senior Citizens
In accordance with P.L. 1986, Chapter 11, general hospitals in NJ with an average of 20 percent or more weekend vacancy rate over a six-month period may establish a Hospital Respite Care Program for persons 65 or older. Under this program, otherwise empty hospital facilities, in a section separate from medical and surgical patients, may be used to provide shelter, food, recreation, and supervision to persons dependent mainly upon family members or others for their care.
For information on whether any hospital in your area has this program, please contact your Area Agency on Aging. Any hospital wishing to start this program, should contact the NJ Department of Health and Senior Services, Licensing Program, PO Box 367, Trenton, NJ 08625-0367, telephone 609-292-9900.
Boarding Homes/Residential Health Care Facilities
Residents who are eligible for Supplemental Security Income (SSI) or General Public Assistance are entitled to receive a monthly personal needs allowance. SSI recipients who receive their own checks do not receive a personal needs allowance.
For information, please contact your County Board of Social Services/ Welfare Agency.
Nursing Homes
Selection/Evaluation
To assist persons in selecting a nursing home or a residential health care facility, the Division of Licensing and Evaluation, NJ Department of Health and Senior Services, offers "Selecting a Long-term Care Facility: A Guide for New Jersey Consumers," which contains general information & location of these facilities by county. In addition, the Division maintains a deficiency profile on each nursing home, indicating its size, staff to patient ratio, and the number of valid complaints about the facility.
For copies of the above publication, or for further information, please contact the Division of Long Term Care Systems, Department of Health and Senior Services, PO Box 367, Trenton, NJ 08625-0367, telephone, toll-free, 1-800-367-6543, or call 609-633-8990.
Nursing Home Pre-Admission Screening Program
The State of New Jersey has a Nursing Home Pre-Admission Screening Program to determine the needs of Medicaid-eligible individuals, or individuals who will be Medicaid eligible following admission to nursing facilities prior to placement in such facilities.
The Nursing Home Pre-Admission Screening Program is administered by the Division of Aging and Community Services, Office of Community Choice Options, Department of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807, telephone 609-943-4978 or toll-free 1-877-856-0877.
Nursing Home Services
All nursing homes are required to provide services to meet the total needs of their patients. Services to be provided include: (a) medical and nursing, (b) diagnostic, 8 dental, (d) pharmaceutical, (e) rehabilitative, (f) dietary, (g) recreational and social, and (h) religious.
For further information, or to file a complaint regarding services, please contact the Division of Licensing and Certification, NJ Department of Health and Senior Services, PO Box 367, Trenton, NJ 08625-0367, telephone 1-800-792-9770 or 609-633-8991. For complaints concerning mistreatment of patients in a nursing home, age 60+, contact the Ombudsman for the Institutionalized Elderly, PO Box 807, Trenton, NJ 08625-0807, telephone 1-877-582-6995 or 609-943-4023.
"Medicaid" Beds
Nursing homes are required to maintain a bed for a period of up to ten days for any resident receiving Medicaid payments who are absent from the facility due to hospital admission or therapeutic leave. In addition, such a person shall continue to be covered by Medicaid for the number of days (up to ten) that the nursing home maintains his/her bed. Should a resident not be able to return to the nursing home before the end of the ten-day period, he/she will have priority for the next available bed in the facility.
For further information, please contact the Office of Community Choice Options, Department of Health and Senior Services, PO Box 807, Trenton, NJ 08625-0807, telephone 609-943-4978, or toll-free 1-877-856-0877.
Health and Medical Programs
General
General
