Medicare vs Medicaid Home Care in New Jersey: What Each Covers

Most families assume Medicare covers home care. It does — but only a narrow slice of it, and only temporarily. The distinction between Medicare home health and Medicaid home care is the difference between a few weeks of skilled nursing visits and years of daily personal care aide services.

What Medicare Covers

Medicare home health covers short-term, intermittent skilled care for beneficiaries who meet three conditions:

1. Homebound status: Your parent is confined to the home and leaving requires considerable effort. Occasional trips to the doctor or church do not disqualify them.
2. Skilled care need: A physician must certify that your parent requires intermittent skilled nursing, physical therapy, occupational therapy, or speech therapy.
3. Medicare-certified agency: Services must be delivered by a licensed Home Health Agency (HHA) certified by Medicare.

Medicare home health covers:

• Skilled nursing visits (wound care, injections, catheter management)
• Physical, occupational, and speech therapy
• Medical social worker visits
• Limited home health aide visits (only while receiving skilled services)

What Medicare does not cover: Long-term custodial care. If your parent needs daily help with bathing, dressing, meal preparation, and mobility — but does not require skilled nursing — Medicare will not pay. Once the skilled care need ends, the home health benefit stops.

In 2026, Medicare Part B carries a standard monthly premium of $202.90, an annual deductible of $283, and no separate deductible for home health services.

What Medicaid MLTSS Covers

Medicaid MLTSS in New Jersey covers long-term personal care — the daily, hands-on assistance that Medicare excludes. If your parent qualifies (income at or below $2,982/month, assets at or below $2,000, Nursing Facility Level of Care), MLTSS provides:

• Personal care assistant services up to 40 hours per week
• Home modifications (ramps, grab bars, stairlifts)
• Home-delivered meals
• Adult day care and medical day care
• Personal emergency response systems
• The Personal Preference Program for family-paid caregiving

MLTSS is an entitlement — there is no waitlist and no annual benefit cap. Services continue as long as your parent remains clinically and financially eligible.

The Overlap: Dual-Eligible Beneficiaries

Many seniors qualify for both Medicare and Medicaid. In New Jersey, dual-eligible beneficiaries receive:

• Medicare for acute care: hospital stays, doctor visits, short-term home health, prescriptions (Part D)
• Medicaid MLTSS for long-term care: daily personal care, home modifications, adult day care

These benefits are coordinated through your parent's MCO. The MCO manages both the Medicaid long-term care benefits and often administers a Medicare Advantage plan as well, simplifying coordination.

When Medicare Home Health Runs Out

The most dangerous moment is when Medicare home health services end — usually after a hospital discharge and rehab stay — and the family realizes that long-term personal care is not covered. If your parent has not yet applied for Medicaid, there is a gap during which private pay is the only option.

Start the Medicaid application as early as possible, even while your parent is still receiving Medicare home health services. The CWA takes 45 to 90 days to process financial eligibility, and the OCCO clinical screening takes another 15 to 30 days. Beginning the application during a Medicare home health episode ensures that MLTSS services can begin as soon as Medicare coverage ends.

The New Jersey Home Care Guide includes a Medicare-to-Medicaid transition timeline and a checklist for coordinating both programs so your parent is never left without coverage.

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