How to Apply for MLTSS in NJ: Step-by-Step Application Guide
What MLTSS Is and Why It Matters
Managed Long Term Services and Supports is New Jersey's single Medicaid program for long-term care. Whether your parent needs a home health aide, assisted living, or nursing home placement, the pathway runs through MLTSS. New Jersey folded all its old Medicaid nursing-home and home-care benefits into this managed care framework, so there is no alternative route — every subsidized long-term care arrangement in the state flows through an MLTSS-enrolled Managed Care Organization (MCO).
The application has two independent tracks that run in parallel: clinical eligibility (does your parent need institutional-level care?) and financial eligibility (does your parent meet the asset and income limits?). Both must be approved before benefits begin.
Step 1: Request a Clinical Screening (OCCO PAS)
The Office of Community Choice Options (OCCO) administers the Pre-Admission Screening (PAS) to determine whether your parent meets the "nursing facility level of care" standard.
How to start: Contact your county Aging and Disability Resource Connection (ADRC) at 1-877-222-3737 and request a PAS referral. The ADRC coordinator submits Form CP-2 to OCCO on your behalf.
What happens next: OCCO conducts an assessment of the parent's ability to perform activities of daily living — bathing, dressing, toileting, transferring, eating — along with cognitive function, behavioral issues, and medical complexity.
What you need to prepare:
- Form PA-4 (Physician Certification) completed by your parent's attending doctor, documenting the diagnosis and functional limitations
- A current medication list
- Medical records documenting the cognitive or physical impairments
Hospital shortcut: If your parent is currently hospitalized and being discharged to a nursing facility, the hospital discharge planner can trigger a Hospital Enhanced At Risk Criteria (EARC) screening. This provides a temporary 90-day authorization, bypassing the standard community PAS timeline.
Step 2: File the Financial Medicaid Application
While the clinical screening is being processed, file the NJ FamilyCare Aged, Blind, and Disabled (ABD) / MLTSS financial application through your County Welfare Agency (CWA) or County Board of Social Services.
2026 financial thresholds:
- Monthly gross income cap: $2,982 (300% of the Federal Benefit Rate)
- Countable asset limit: $2,000 for the applicant
- 60-month look-back period on all asset transfers
Documents to gather — and this is where most applications stall:
- 60 months of statements for every bank account, investment account, and retirement account (open or closed)
- Real estate deeds and property tax cards
- Life insurance policies with cash surrender values
- Proof of all monthly income (Social Security, pensions, annuities)
If income exceeds $2,982: You must establish a Qualified Income Trust (Miller Trust) and submit the trust document alongside the application. The trust must name a trustee other than the applicant, be irrevocable, and name the State of New Jersey as the primary beneficiary upon death. Read more at Qualified Income Trust New Jersey.
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Step 3: Choose an MCO and Build the Plan of Care
Once both clinical and financial eligibility are confirmed, NJ FamilyCare lets you select a Managed Care Organization. The active MCOs in the MLTSS program manage the actual delivery of services.
Contact the MCO Enrollment Broker at 1-866-472-5338 to choose a plan. Key considerations:
- Which MCO has the best provider network in your county (home health agencies, assisted living facilities, nursing homes)?
- Does the MCO's care manager respond to calls within a reasonable timeframe?
- What is the MCO's track record on authorizing adequate home-care hours?
After enrollment, the MCO assigns a care manager who develops a Plan of Care (POC). This document specifies exactly which services your parent receives — how many hours of home health aide per week, adult day care, durable medical equipment, or facility placement.
Self-direction option: Through the Personal Preference Program (PPP), your parent can hire family members — including a spouse or adult child — as paid personal care assistants under the MLTSS plan. This is one of the few ways a family caregiver can get paid for the care they are already providing.
Common Application Mistakes
Missing the full 60-month lookback: Families often provide 12 or 24 months of statements and are told to go back further. Gather all 60 months before filing.
Filing financial without clinical: Both tracks must be approved. Some families spend months gathering financial documents without requesting the PAS, losing time.
Not establishing the QIT in advance: If your parent's income exceeds the cap, the application will be denied without a trust document. Have the QIT drafted and the bank account opened before you file.
The New Jersey Dementia & Memory Care Guide includes a step-by-step MLTSS application checklist with the complete document preparation list, QIT setup instructions, and the appeal process for clinical or financial denials.
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