Medicaid Pending Nursing Home in New Jersey

The Gap Between Application and Approval

Your parent is in a nursing home. You have submitted a Medicaid MLTSS application through the County Board of Social Services. And now you wait — sometimes 90 days, sometimes 150, sometimes longer in counties with heavier caseloads. That waiting period is called "Medicaid Pending."

During this time, the nursing home is not receiving Medicaid payments for your parent's care. Bills accumulate. The facility's billing office starts calling. In some cases, administrators begin hinting — or outright stating — that your parent needs to leave.

Here is what you need to know: they almost certainly cannot make your parent leave.

The Eviction Ban During Medicaid Pending

Under N.J.A.C. 8:39-4.1(a) 31-32, a Medicaid-certified nursing facility in New Jersey is prohibited from involuntarily discharging or transferring a resident for non-payment while a Medicaid application is actively pending. Federal law (42 C.F.R. § 483.12(a)) reinforces the same protection.

Two conditions must be met for the protection to hold:

1. The application must be pending with required paperwork submitted. The protection applies while the application is pending and all necessary financial and clinical paperwork has been submitted to the County Board of Social Services. Respond promptly to any additional document requests.

2. The resident must be paying their estimated cost share. During the pending period, the resident is required to pay their gross monthly income directly to the facility, keeping only the $50 Personal Needs Allowance and any health insurance premiums. This estimated Patient Responsibility is what the facility expects while Medicaid adjudicates the application.

If both conditions are met, the facility cannot evict your parent. Period.

What to Do If the Facility Threatens Discharge

If a nursing home administrator or social worker tells you that your parent must leave because Medicaid has not been approved yet, take these steps:

Document the threat. Write down the date, time, who said it, and exactly what they said. Keep a record.

Remind them of the law. You can cite N.J.A.C. 8:39-4.1(a) 31-32 directly. Some facilities test families who appear unfamiliar with their rights.

Contact the Long-Term Care Ombudsman. The New Jersey Office of the Long-Term Care Ombudsman investigates complaints against licensed long-term care facilities, including illegal eviction threats. Call 1-877-582-6995 or email [email protected]. Filing a complaint triggers an automatic administrative stay that halts any transfer or discharge pending a formal state hearing.

Confirm your application is active. Call the County Board of Social Services and verify that no outstanding document requests are blocking your application. If the county has sent you a letter requesting additional paperwork, respond immediately. A lapsed application is the one scenario where the facility's legal footing strengthens.

How Billing Works During the Pending Period

Once Medicaid is approved, the County Welfare Agency issues the formal Patient Responsibility calculation. Ask the agency and the facility how the approved eligibility date and calculation apply to bills from the pending period.

During the pending period, you pay the estimated Patient Responsibility each month. This is your parent's gross monthly income minus the $50 Personal Needs Allowance and allowable deductions (health insurance premiums, any spousal income allowance). The County Welfare Agency eventually issues a formal Patient Responsibility calculation, but in the early months, you and the facility work from an estimate.

Keep copies of every payment and ask the facility for a written accounting after the formal calculation comes through.

How Long the Pending Period Lasts

Federal regulations require states to process Medicaid applications within 45 days. In practice, New Jersey processing times vary by county and by the complexity of the applicant's financial profile.

Applications involving the five-year look-back period, asset transfers that need investigation, or incomplete documentation take longer. County caseworkers handle heavy caseloads, and follow-up correspondence can add weeks at each exchange.

If the county exceeds the applicable federal processing deadline without a decision, you have the right to request a fair hearing before an administrative law judge to compel a prompt determination.

Even a Denial Does Not Mean Immediate Eviction

If the Medicaid application is ultimately denied, the facility still cannot discharge your parent unless it secures a safe, documented, and medically appropriate alternative placement. Vague designations like "home" or "other facility" are legally insufficient.

The Hospital-to-Home in New Jersey guide includes the Medicaid application checklist, the Patient Responsibility calculation worksheet, and a template letter for responding to eviction threats.

See more New Jersey guides →