Medicaid Home Care in New Jersey: Eligibility, Benefits & How to Apply

New Jersey Medicaid provides vital home care coverage for thousands of seniors and adults with disabilities who need support to remain safely at home. Understanding how the Medicaid MLTSS program works — who qualifies, what’s covered, and how to apply — is the first step toward accessing the care your family needs. This guide explains NJ Medicaid home care from eligibility through enrollment, with practical advice for NJ families navigating a complex system. If you need care now while your application is pending, (908) 912-6342 — 24 HOUR Home Care NJ can begin private-pay services within 24–48 hours and transition to Medicaid billing once authorized.

What Is NJ Medicaid MLTSS?

New Jersey’s Managed Long Term Services and Supports (MLTSS) is the Medicaid waiver program that funds home and community-based services (HCBS) for elderly and disabled New Jerseyans who require a nursing-facility level of care but prefer — or are able — to remain at home. MLTSS replaced NJ’s previous waiver programs in 2014 and is administered through four Medicaid managed care organizations (MCOs):

• Horizon NJ Health — horizonnj.com
• Aetna Better Health of NJ — aetnabetterhealth.com/new-jersey
• AmeriHealth Caritas NJ — amerihealthcaritatsnj.com
• WellCare of NJ — wellcare.com/new-jersey

Each MCO assigns a care coordinator who helps assess the member’s needs, authorize hours, coordinate providers, and monitor care quality. Your choice of MCO is made during enrollment and can be changed annually. For official program information, visit nj.gov/humanservices/dmahs.

Eligibility Criteria for NJ Medicaid Home Care

To qualify for NJ Medicaid MLTSS home care, an individual must meet both financial and functional (medical) criteria:

Financial Eligibility

• Income (single): Up to 300% of the SSI Federal Benefit Rate — approximately $2,742/month in 2025. Income above this limit may qualify through a “spend-down” (medical deductible).
• Assets (single): $2,000 in countable assets. Exempt assets include the primary home (if the applicant intends to return), one vehicle, term life insurance, personal belongings, and prepaid funeral arrangements.
• Married couples: The community spouse (at home) may retain the “Community Spouse Resource Allowance” (CSRA) — up to approximately $154,140 in assets (2025) — plus a monthly income allowance. These spousal protections prevent impoverishment of the at-home spouse.
• Spend-down: Individuals with income above the limit may still qualify by “spending down” excess income on medical bills, including home care costs.

Functional (Medical) Eligibility

The applicant must require a nursing-facility level of care — meaning they need significant assistance with Activities of Daily Living (ADLs) such as bathing, dressing, mobility, continence, or eating. A state assessor conducts an in-home evaluation using the InterRAI assessment tool to determine functional eligibility.

For detailed program rules and income thresholds, visit medicaid.gov or nj211.org for local referrals.

What Home Care Services Does NJ Medicaid Cover?

Under MLTSS, authorized home care services may include:

• Personal care assistance — Bathing, dressing, grooming, toileting, mobility, transfers
• Companion care — Meal preparation, light housekeeping, medication reminders, supervision
• Home health aide services — Skilled-level personal care by certified aides, RN oversight
• Skilled nursing visits — Wound care, medication management, health monitoring by licensed nurses
• Adult day services — Structured daytime programs at licensed adult day health centers
• Respite care — Temporary relief for family caregivers
• Personal Emergency Response Systems (PERS) — Medical alert devices
• Home modifications — Ramps, grab bars, and other safety modifications (subject to authorization)
• Transportation — Non-emergency medical transportation to appointments

The number of hours authorized depends on the member’s functional assessment, the care plan developed with the MCO, and available program funding. Many families find that Medicaid-authorized hours cover basic needs but supplement with private-pay hours for additional coverage. Our RN can help assess how many additional hours may benefit your loved one.

How to Apply for NJ Medicaid Home Care

Applying for NJ Medicaid MLTSS involves several steps. Starting the process early is critical — the application can take 45–90 days to complete, and care needs don’t wait.

1. Contact NJ EASE: Call 1-877-222-3737 (toll-free) to reach New Jersey’s Easy Access Single Entry system. NJ EASE connects callers to their county’s Aging and Disability Resource Connection (ADRC), which screens for Medicaid eligibility and initiates the application. You can also visit nj211.org for local resources.
2. Complete the Medicaid application: Submit Form A to NJ Medicaid (through NJ EASE or directly at your local County Board of Social Services). You’ll need proof of income (Social Security statements, pension letters), proof of assets (bank statements, investment accounts), identification, Medicare card, and proof of NJ residency.
3. Functional assessment: A state assessor visits the home to evaluate the applicant’s ADL needs using the InterRAI tool. This assessment determines whether the individual meets the nursing-facility level of care standard.
4. MCO enrollment: Once financially and functionally approved, you choose your MCO (Horizon, Aetna, AmeriHealth, or WellCare) and are assigned a care coordinator.
5. Care planning: The MCO care coordinator develops a Person-Centered Service Plan (PCSP) with you and your family, identifying what services, hours, and providers are authorized.
6. Service authorization and provider selection: Once your plan is approved, you select a licensed home care provider from the MCO’s network. Care begins after written authorization is issued.

Important: Do not wait until a crisis to apply. Start the process as soon as possible. While your application is pending, (908) 912-6342 — we provide private-pay care immediately and can transition to Medicaid billing once authorized.

Personal Care vs. Companion Care Under Medicaid

NJ Medicaid distinguishes between personal care and companion care:

The Role of Elder Law Attorneys in Medicaid Planning

For families with assets above Medicaid limits, Medicaid planning with a NJ-licensed elder law attorney can be essential. Strategies such as irrevocable Medicaid asset protection trusts (MAPTs), Medicaid-compliant annuities, and caregiver child transfers may help families protect assets while qualifying for Medicaid. The NJ State Bar Association’s Elder Law Section (njsba.com) can help locate a qualified elder law attorney in your county.

Common Medicaid planning documents include a Durable Power of Attorney (allowing a designated person to manage finances during the application process) and a Healthcare Proxy (designating a healthcare decision-maker). If your loved one lacks these documents, consult an attorney before the Medicaid application — an incapacitated individual may require court-ordered guardianship, which adds time and cost.

Supplementing Medicaid with Private Pay

Medicaid authorizes care based on assessed needs, but families often want more coverage than Medicaid provides — additional hours in the morning, overnight supervision, or a specific caregiver. Private-pay home care from 24 HOUR Home Care NJ allows families to supplement Medicaid-authorized hours with additional coverage:

• Gap coverage: Medicaid authorizes 4 hours/day; private pay adds 2 hours/day for meals and medication reminders
• Overnight supervision: Medicaid often does not cover overnight hours; overnight care can be arranged privately
• Caregiver consistency: Private-pay allows families to request specific caregivers beyond Medicaid’s assignment process
• Faster start: Private pay begins within 24–48 hours; Medicaid authorization may take weeks

Call (908) 912-6342 to discuss how we can coordinate Medicaid-authorized hours alongside private-pay services for seamless, comprehensive coverage.

NJ Medicaid Home Care — Frequently Asked Questions

Does NJ Medicaid pay for home care?

Yes. New Jersey Medicaid covers home care through the Managed Long Term Services and Supports (MLTSS) program. Eligible individuals can receive personal care, companion care, home health aide services, and other supports delivered in the home. To begin, call NJ EASE at 1-877-222-3737 or visit nj.gov/humanservices/dmahs. Call us at (908) 912-6342 to discuss private-pay options alongside Medicaid.

What are the income and asset limits for NJ Medicaid home care?

For NJ Medicaid MLTSS, a single individual may have monthly income up to 300% of the SSI Federal Benefit Rate (approximately $2,742/month in 2025) and countable assets up to $2,000. A married couple has higher thresholds with spousal protections. Some assets — primary home, one vehicle, personal property — are generally exempt. An elder law attorney or NJ EASE can help families navigate spend-down strategies.

What is the difference between MLTSS and regular NJ Medicaid?

Regular NJ Medicaid covers medical services like doctor visits and hospitalizations. MLTSS (Managed Long Term Services and Supports) is the Medicaid waiver program specifically for long-term care, including home and community-based services (HCBS). MLTSS is administered through managed care organizations (MCOs) — Horizon NJ Health, Aetna Better Health of NJ, AmeriHealth Caritas, and WellCare of NJ — that coordinate home care services for members.

How do I apply for Medicaid home care in New Jersey?

Apply through NJ EASE (Easy Access Single Entry) at 1-877-222-3737 or visit your county’s Area Agency on Aging. You’ll complete a financial eligibility application with NJ Medicaid and a functional assessment. The process typically takes 45–90 days. For immediate private-pay care while your Medicaid application is pending, call us at (908) 912-6342.

Can I choose my own home care agency under NJ Medicaid?

Yes. Once enrolled in MLTSS, you work with your MCO care coordinator to select a provider. You have the right to choose a licensed agency that does not accept Medicaid directly. Call your MCO directly to confirm coverage and obtain an authorization before services begin. Families who prefer a specific caregiver or more hours than Medicaid authorizes often supplement Medicaid with private-pay hours.

What if my family member needs more care than Medicaid authorizes?

Medicaid authorizes hours based on functional assessment — sometimes fewer than a family needs. Many NJ families supplement Medicaid-authorized hours with private-pay hours from 24 HOUR Home Care NJ to ensure full coverage. We accept private pay, long-term care insurance, and Veterans benefits. Call (908) 912-6342 for a free assessment.

We serve seniors across New Jersey: Union County, Essex County, Morris County, Middlesex County, Bergen County, Somerset County, Passaic County, Hunterdon County, Mercer County, Monmouth County, Ocean County.

Our services: 24-Hour Home Care | Live-In Care | Companion Care | Personal Care | Dementia Care | Alzheimer’s Care | Overnight Care | Respite Care | Geriatric Care | Long-Term Care | Home Health Aide.