FINANCING NURSING HOME CARE IN NEW JERSEY
by Thomas D. Begley, Jr.
1. INTRODUCTION
Statistics show that approximately 60 percent of the population age 65 or over will require some form of long-term care. Some will be there for relatively short periods of time. These are usually stroke victims who are doing rehabilitation. A significant percentage will remain in a nursing home for an extended period of time. These are usually Alzheimer's or Parkinson's patients.
A statistic widely quoted is that the average stay in a nursing home is 2.9 years. This statistic is somewhat misleading, because the persons receiving rehabilitation are often discharged in six months or less. The long-term patients may stay in the nursing home for many years.
Unfortunately, as the population ages, the cost of health care is increasing, and government entitlement programs are being cut back. The cost of a nursing home in New Jersey today is approximately $100,000/$120,000 per year. Some nursing homes are slightly less, and some are significantly more.
There are five sources for nursing home payment. They are: private pay, long-term care insurance, Medicaid, Medicare, and Veterans Administration.
2. MEDICAID
2.1. Administration
This is a program administered by the states and funded by both federal and state governments. Rules vary from state to state. In New Jersey, Medicaid is administered by the County Welfare Boards. Medicaid pays for nursing home care for eligible individuals.
2.2. Eligibility
2.2.1. Citizenship and Residency
Must be a U.S. Citizen or resident alien and a resident of New Jersey.1 An individual is not allowed to enter New Jersey solely in order to receive Medicaid.
2.2.2. Categorical
Must be 65 years of age or older3 unless blind or disabled.4 “Blindness” means visual acuity of 20/200 or less in the better eye with use of a correcting lens.5 “Disability” is defined as the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment, which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months.
2.2.3. Medical Eligibility
Must also be eligible from a medical standpoint. This is done by a Medicaid nurse completing a necessary form stating the diagnosis, medication, etc.
FINANCING NURSING HOME CARE IN NEW JERSEY
