New Jersey Medicaid for Long-Term Care: The Basics of MLTSS

By the care managers at Connections Care Management · Updated November 2026

First, an important note

We are care managers, not attorneys or financial advisors. This page is general information to help you understand the basics and ask good questions. Medicaid rules are detailed, and income and asset limits change regularly. Confirm current rules and figures with your county Board of Social Services, the county Aging and Disability Resource Connection or an elder law attorney before making decisions.

What is MLTSS?

MLTSS stands for Managed Long Term Services and Supports. It is New Jersey’s Medicaid program for long-term care, part of NJ FamilyCare. Services are delivered through managed care organizations (health plans) that participate in the state’s Medicaid program. Each member works with the plan on a care plan.

Depending on need, MLTSS can include:

• Home and community services such as personal care assistance, home health aide services, respite, home delivered meals, home and vehicle modifications, a personal emergency response system, adult day health services, and mental health and addiction services.
• Care in assisted living and other community residential settings.
• Nursing home care.

Who may qualify for MLTSS?

According to the state, a person generally must meet these requirements:

• Age or disability: 65 or older, or under 65 and determined blind or disabled by the Social Security Administration or the State of New Jersey.
• Residency and status: a New Jersey resident who is a U.S. citizen or qualified noncitizen.
• Clinical need: requires, or will require within 30 days, the level of care typically provided in a nursing home, such as help with bathing, toileting and mobility.
• Financial: meets NJ FamilyCare limits on monthly income and countable assets, with a five-year look-back.

We are not listing dollar limits here on purpose. They change, and the details (what counts as income, what assets are excluded, rules for married couples) matter a great deal.

How does the application work?

There are two parts that run side by side:

1. Financial eligibility. You apply for NJ FamilyCare through your County Welfare Agency or Board of Social Services. Expect to provide extensive financial records.
2. Clinical eligibility. A clinical assessment determines whether your loved one needs nursing home level care. Your county Area Agency on Aging, which also serves as the Aging and Disability Resource Connection (ADRC), can provide information and screening. The statewide ADRC number is 1-877-222-3737.

Once both are approved, your loved one enrolls in a managed care plan and receives a care plan.

What is the five-year look-back?

When someone applies for Medicaid long-term care, the state reviews financial transactions over the previous five years. Gifts or transfers of assets for less than fair value during that period can lead to a penalty period, during which Medicaid will not pay for long-term care. This is why giving money to children “to qualify” can backfire badly. Talk with an elder law attorney before moving any assets.

What records should we start gathering?

Financial applications go more smoothly when records are organized early. Typical items include:

• Identification, Social Security and Medicare cards, and proof of residency.
• Proof of all income: Social Security, pensions, annuities, other payments.
• Bank, brokerage and retirement account statements, often going back five years.
• Life insurance policies.
• Deeds, property records and vehicle titles.
• Records of any large gifts, transfers or withdrawals, with explanations.
• Health insurance cards and any long term care insurance policy.
• Powers of attorney and any trust documents.

Missing or unexplained transactions are a common cause of delays.

What if income is above the limit?

New Jersey allows a Qualified Income Trust (QIT) for some applicants who need an institutional level of care and whose income is above the limit. Income placed in the trust is not counted for financial eligibility, but the trust has strict rules about how funds are used, and the state is the first beneficiary of remaining funds after death up to what Medicaid paid. This is an area where an elder law attorney is essential.

What about a spouse who stays at home?

Medicaid has rules meant to keep a spouse who remains at home from being left without resources. How these protections apply depends on the couple’s situation and current figures. Ask an elder law attorney to explain them for your family.

What is estate recovery?

New Jersey seeks repayment from the estates of Medicaid beneficiaries for services received at age 55 or older. Recovery is deferred while there is a surviving spouse, a child under 21, or a child who is blind or permanently disabled, and there are other exceptions. The definition of “estate” can be broad. Ask an attorney how this applies to your family.

Common mistakes to avoid

• Giving away money or property without legal advice.
• Waiting until savings are nearly gone to start planning.
• Assuming every assisted living accepts Medicaid. Many do not, or limit it.
• Missing deadlines or requests for information from the county.
• Assuming Medicare will pay for long-term care. It does not cover custodial care.
• Relying on general internet advice instead of current, local guidance.

Are there other NJ programs to know about?

Some people who are not financially eligible for Medicaid may qualify for state programs such as Jersey Assistance for Community Caregiving (JACC) or the Statewide Respite Care Program, which have their own rules and income-based copays. Ask your county ADRC. For Rockland County, NY residents, New York has its own Medicaid long-term care rules; start with the Rockland County Office for the Aging or an elder law attorney licensed in New York.

Questions to ask an elder law attorney

1. Based on our situation, when should we apply, and what should we do first?
2. Which of our parent’s assets are countable, and which are exempt?
3. How do the spousal protections apply to us?
4. Are any past gifts or transfers a problem under the look-back?
5. Is a Qualified Income Trust needed?
6. How might estate recovery affect the home?
7. What documents should be updated now?

How Connections Care Management can help

We do not give legal advice, but we help families with the practical side of benefits every day. Through our benefits and paperwork help, we can organize records, help with forms, follow up with agencies and keep track of deadlines, working alongside your elder law attorney. We can do a care assessment to clarify what level of care your loved one actually needs, and help you compare settings, including which assisted living and nursing home options accept Medicaid. Once services begin, our ongoing care management can help make sure the plan works in real life.

Contact us for a free first conversation.