Applications for Medicaid/MLTSS are still being accepted at the County Boards of Social Services

Increasing numbers of frail elderly are trying to arrange for care in their houses or apartments because admission to nursing facilities is so problematic at this time. About one third of the state’s skilled nursing facilities are considered to be incapable of appropriately isolating COVID-19 patients, and have been  barred from any new admissions. Of course, arranging for home care is increasing difficult due to a serious shortage of trained personnel who are capable and willing — understandably — to go into a home setting, due to the risk of infection. Geriatric care managers (Aging and Life Care Specialists) can be very useful in establishing a home care arrangement, even in these trying times.

The Medicaid/MLTSS program can provide home and community -based services to financially-eligible individuals who are over 65 or are disabled and who require hands-on care and supervision with 3 or more of their activities of daily living. It is necessary to contact the Office of Community Choice Options (OCCO) to order the Pre-Admission Screening (PAS). Here’s the latest list of offices and contact numbers.  MLTSS and OCCO Contact List 3.20.20

Previously, this evaluation took place at the residence of the applicant. Now it is being done by telephone. It’s very important to order the PAS because an applicant must be clinically in need of these long-term care services in order to be approved for Medicaid/MLTSS services. To do so, first the family/caregiver calls the ADRC (Aging Disability Resource Connection) in their county.  The ADRCs are sort of the portal-of-entry to gain access to many different government programs. The ADRC will complete the first telephone screening. https://www.state.nj.us/humanservices/doas/home/saaaa.html  The ADRC will then send their screening to OCCO.  The OCCO nurse will contact the family to review the initial screening and gather additional information.

 

Office of Community Choice Options:

While awaiting the PAS evaluation, it’s necessary to address the financial eligibility requirements, which are stringent and complex. Legal sandtraps are everywhere in the process. The application is then filed at the local County Board of Social Services once all of those benchmarks have been reached.

Call for advice and assistance with medicaid eligibility, applications and appeals … 732-382-6070

Top ten reasons to hire a lawyer for a Medicaid application

The Medicaid program for long-term care was created by Congress decades ago and is administered by the States and their myriad separate counties. Did you know that there are at least 11 bodies of law that interpret this  byzantine program? From top to bottom we have the Federal Medicaid statutes (42 USC 1396); the Social Security statutes pertaining to the SSI program (42 USC 1382); SSI regulations (20 CFR 416); SSI POMS interpretive rulings; CMS’ State Medicaid Manual and updated  interpretive documents that have the authority of regulations; NJ Medicaid statutes;  NJ state Medicaid regulations (NJAC 10:71 and 10:70); federal case law; NJ case law; NJ administrative Initial Decisions and  Final Agency Decisions (FAD’s); and the NJ Division of Medical Assistance and Health Services (DMAHS) periodic communications (MedComs). Then there are the overlays such as the Due process clause of the  federal and state constitutions, and other laws that provide protections to elders such as the nursing home reform act… when I teach elder law to lawyers, I remind them that they need to be familiar with all of this. So here are the top ten reasons:

1st  Lawyers are trained to understand and creatively interpret the law for benefit of their client;

2nd Your lawyer is subject to state ethical requirements through the Rules of Professional Conduct.

3rd  Your lawyer has a duty of exclusive loyalty to your interests and must avoid conflicts of interest which could harm your interests..

3rd Your lawyer has a duty to zealously represent your interests.

4th Your lawyer has a duty to diligently represent your interests

5th Your lawyer has a duty to preserve your confidences.

6th Your lawyer will advise you when a health care facility or nursing home  is violating its obligations or overstepping its legal rights.

7th Your elder care lawyer will tell you how you can preserve your family assets by applying the Medicaid law to your best advantage

8th  Applying for Medicaid involves a complex legal transaction with a high rate of denials, and it’s not just a matter of assembling a pile of documents and sending them to the county board of social services.

9th Your lawyer can identify and help solve the legal problems that arose before you stepped in to help your parent with Alzheimers or other dementias.

10th  If your lawyer breaches their duty to you, you actually have recourse and remedies.

We’ve been representing clients in Medicaid applications and appeals for twenty years … call for appointment 732-382-6070