NJ FamilyCare and MLTSS: how Medicaid pays for long-term care

Many families find out the hard way that Medicare does not pay for ongoing help with bathing, dressing or meals. It covers short rehab stays and some home health visits after an illness. It does not cover long-term custodial care. In New Jersey, the program that does is Medicaid, known here as NJ FamilyCare, through a benefit called Managed Long Term Services and Supports (MLTSS).

The rules are detailed and the paperwork is heavy. Families who understand the basics early tend to avoid the costly mistakes. Here is what you need to know.

What is MLTSS and who is it for?

MLTSS delivers long-term care through private health plans, called managed care organizations (MCOs), that contract with NJ FamilyCare. Each member gets a care manager who helps plan services. You may qualify if you:

• Are 65 or older, or under 65 and determined blind or disabled by Social Security or the State of New Jersey.
• Live in New Jersey and are a U.S. citizen or qualified noncitizen.
• Need nursing-home-level care now or within 30 days (the clinical test).
• Meet NJ FamilyCare's income and asset rules, including the five-year look-back (the financial test).

Five MCOs offer MLTSS: Aetna Better Health of New Jersey, Amerigroup New Jersey, Horizon NJ Health, UnitedHealthcare Community Plan and WellCare Health Plans of New Jersey. All five serve every county except that WellCare does not serve Hunterdon. To ask about choosing or changing a plan, call 1-866-472-5338 (TTY 1-800-701-0720).

What are the financial limits in 2026?

These are the key numbers for long-term care Medicaid in New Jersey. Federal standards change every January, and some spousal figures change in July.

Rule	2026 figure
Applicant's monthly income limit (300% of the SSI benefit of $994)	$2,982
Countable assets, single applicant	$2,000
Assets a spouse at home may keep (Community Spouse Resource Allowance)	Half the couple's assets, at least $32,532 and at most $162,660
Minimum monthly income for a spouse at home (from July 1, 2026)	$2,705
Maximum monthly income allowance for a spouse at home	$4,066.50
Home equity limit (if you live there or plan to return)	$1,130,000
Look-back period for transfers	60 months
Penalty divisor (April 1, 2026 to March 31, 2027)	$420.67 a day

What if income is over $2,982?

You may still qualify. New Jersey lets applicants put the income above the limit into a Qualified Income Trust, sometimes called a Miller Trust. The money in the trust then goes toward the cost of care. Setting one up correctly matters, so most families use an elder law attorney.

What counts as an asset?

Bank accounts, CDs, stocks, bonds, most retirement accounts and cash value life insurance usually count. Your home generally does not count while you or your spouse lives there, as long as your equity is under the limit. One car and a prepaid, irrevocable funeral arrangement are commonly excluded too. Ask the county agency before you spend down, because the details matter.

How does the five-year look-back work?

When you apply for MLTSS, the state reviews every transfer you made in the 60 months before your application. It is looking for money or property you gave away, or sold for less than it was worth.

If it finds one, you face a penalty period when Medicaid will not pay for your long-term care. The state divides the amount transferred by the penalty divisor. Say a widow in Toms River gave her grandson $42,067 toward a house three years before applying. $42,067 divided by $420.67 equals 100 days without Medicaid coverage for her care. The penalty clock starts only after she is otherwise eligible, which is often when savings are gone.

Some transfers are allowed, such as transfers between spouses. Others depend on the facts, like transfers to a disabled child or a caregiver child who lived in the home. If you are thinking about giving money away, talk to an elder law attorney first. Our estate planning guide explains how to find one.

Keep in mind that New Jersey may seek repayment from the estate of a member who was 55 or older for services Medicaid paid for. This is called estate recovery. Ask about it when you plan.

What does clinical eligibility mean?

Being old enough and poor enough is not enough. You also have to need nursing-home-level care. In practice, that usually means needing hands-on help with several activities of daily living, such as bathing, dressing, toileting, moving from bed to chair or eating. Significant cognitive impairment, as with dementia, can also qualify.

A trained assessor visits in person and uses the state's assessment tool. The state's Office of Community Choice Options makes the clinical decision. Before the visit, write down every task your parent needs help with and how often. Families often understate needs out of pride. Be honest and specific.

What does MLTSS cover at home, in assisted living and in a nursing home?

The care plan is built around assessed need. Services can include:

• At home: personal care assistants, home health aides, adult day health, respite for family caregivers, home-delivered meals, a personal emergency response system, home modifications such as grab bars or ramps, and vehicle modifications.
• Assisted living and community residential services: care services in a participating residence. Members generally contribute most of their income toward the cost, and not every assisted living residence accepts Medicaid. Some require a period of private pay first, so ask before you move in.
• Nursing home care: full coverage in a Medicaid-certified facility. Most of the resident's income goes toward the bill, minus a small personal needs allowance.
• Behavioral health: mental health and addiction services.

Most people prefer to stay home. MLTSS was built partly to make that possible. Read our aging in place guide for other ways to stay home safely.

What is PACE, and is it in my county?

The Program of All-Inclusive Care for the Elderly (PACE) is another option. A PACE organization runs a day center with doctors, nurses, therapists, social workers and transportation, and it handles all of your care. Medicare and Medicaid pay for it. To join, you must be 55 or older, need nursing-home-level care, be able to live safely in the community with PACE services and live in the program's service area.

In January 2026 the state announced funding to bring PACE to all 21 counties. Programs open in stages, so check availability for your ZIP code. Fully operating programs listed by the state:

• AtlantiCare LIFE Connection (Atlantic City): Atlantic and Cape May counties
• BoldAge PACE (Lakehurst): Ocean County
• BoldAge PACE (Oceanport): Monmouth County
• Capital Health LIFE (Bordentown): Mercer County and parts of Burlington
• Inspira LIFE (Vineland and Williamstown): Cumberland, Gloucester and Salem counties
• Lutheran Senior LIFE (Jersey City): most of Hudson County
• Trinity Health LIFE New Jersey (Pennsauken): most of Camden County and parts of Burlington

Sites in development will serve Middlesex, Union, Somerset, Hunterdon, Passaic, Essex, Bergen, Sussex, Warren and Morris counties. The state keeps a current list on its PACE page.

How do I apply?

Applying is a two-track process. One track checks finances. The other checks care needs.

If you are denied, the notice explains your right to a fair hearing and the deadline to ask for one. Ask for help from an elder law attorney or Legal Services of New Jersey. For caregivers juggling all this, our respite guide may help you catch your breath.

Common questions

Does Medicare pay for a nursing home?

Only for short skilled stays after a qualifying hospital stay, up to 100 days with a daily coinsurance after day 20. It does not pay for long-term custodial care. In New Jersey, Medicaid through MLTSS is the main public payer for long-term care.

What is the 2026 income limit for MLTSS?

$2,982 a month for the applicant. If income is higher, a Qualified Income Trust may allow you to qualify.

Will my spouse be left with nothing?

No. A spouse who stays at home can keep half of the couple's countable assets, between $32,532 and $162,660 in 2026, plus the home in most cases, and may receive part of the applicant's income to reach a minimum monthly amount.

Can I get MLTSS at home instead of a nursing home?

Yes. MLTSS covers personal care, home health aides, adult day health, home-delivered meals, respite and home modifications based on your assessed needs.

Where do I start?

Call your county Aging and Disability Resource Connection at 1-877-222-3737. They can screen you, explain MLTSS and PACE, and point you to your County Welfare Agency to apply.

This guide is for general information. Program rules and income limits change, so confirm with the official source before you apply.