In our practice, we often have clients and/or family members of clients who have done extensive research on Medicaid.  This research (whether accurate or inaccurate) often leaves our clients with more questions than answers and with more confusion than clarity.  Some clients have a tendency to delve into the more complicated issues related to qualifying for Medicaid and skip the basics. 

Before any plan can be put in place for a client who is interested in qualifying for Medicaid, it is important to understand the basic eligibility rules that must first be met before Medicaid will pay for long-term care expenses.  Although each state’s rules vary, below are the five basis rules for Medicaid eligibility:

  1. The applicant must be a citizen of the United States or a “qualified alien.”  A permanent resident is a “qualified alien.”
  2. The applicant must also be deemed a resident of the state in which he or she would like to qualify for Medicaid.  This test is simple in most states, including New Jersey.  All that is required is physical presence in the state with no intent to move out.
  3. The applicant must be medically needy.  In New Jersey, this means you have to be determined disabled either by the Social Security Administration or by the New Jersey Department of Medical Assistance and Health Services.  Disability is typically scored by looking at how much assistance is required for activities of daily living.
  4. The applicant must meet the resource requirement.  In New Jersey, this requirement for long-term care Medicaid is $2,000 for a single person and $3,000 for a married applicant.  For the New Jersey “Medically Needy Program,” the resource requirement is $4,000.
  5. The applicant must meet the income requirement.  InNew Jerseyfor 2013, the an applicant for long-term care Medicaid cannot have more than $2,130 of income per month.  An applicant with income in excess of this cap will not qualify for the long-term care Medicaid.  He or she may qualify for the “Medically Needy” Medicaid if a majority of the applicant’s income is being used to pay for his or her medical care.