NJ Choice Assessment Tool: How to Prepare for Your Home Care Assessment

The clinical assessment is the gate between your parent and Medicaid home care services. In New Jersey, the Office of Community Choice Options (OCCO) uses the NJ Choice Assessment Tool — built on the interRAI Home Care framework — to determine whether your parent meets Nursing Facility Level of Care (NFLOC). If they pass, MLTSS home care services are authorized. If they do not, the family is left with private pay or state-funded alternatives.

What NFLOC Means

Nursing Facility Level of Care is the clinical standard that determines whether someone is sick or disabled enough to need the type of care a nursing home provides. Under N.J.A.C. 8:85-2.1, your parent qualifies if they:

• Need hands-on physical assistance with at least three Activities of Daily Living (ADLs): bathing, dressing, toileting, transferring, or locomotion
• Have severe cognitive deficits that compromise their personal safety (wandering, inability to recognize danger, inability to manage medications)

Meeting either standard satisfies NFLOC. A parent with advanced dementia who can still dress independently but cannot be left alone safely qualifies on cognitive grounds.

How the Assessment Works

An OCCO registered nurse conducts the assessment in person at your parent's home. The visit typically lasts 60 to 90 minutes. The nurse evaluates:

• Physical function: Can your parent bathe, dress, toilet, transfer from bed to chair, and walk independently? How much assistance do they need for each task — verbal cueing, standby help, or full hands-on assistance?
• Cognitive status: Orientation to time and place, short-term memory, decision-making ability, communication capacity
• Medical complexity: Chronic conditions, medication management, wound care needs, fall history
• Behavioral patterns: Wandering, aggression, resistance to care
• Current support: Who is providing care now, how many hours, and is the arrangement sustainable?

The nurse enters findings into the NJ Choice system, which generates a scored profile. A score indicating high clinical need triggers NFLOC certification and MLTSS enrollment.

How to Prepare

The assessment captures your parent on one specific day. If your parent tends to downplay their difficulties or put on their best face for visitors, the nurse may see a misleadingly capable person. Preparation matters.

Document the worst days, not the best. Keep a written log for 1 to 2 weeks before the assessment: falls, bathroom accidents, confusion episodes, times they forgot to eat or take medications, wandering incidents. Bring this log to the assessment.

Have the primary caregiver present. The nurse will ask the caregiver about the level of assistance provided. The person who bathes, feeds, and monitors your parent daily can describe their needs more accurately than the parent can self-report.

Gather medical records. Have recent hospital discharge summaries, physician notes, medication lists, and any diagnoses related to cognitive or physical decline. A dementia diagnosis from a neurologist carries more weight than a family observation.

Do not coach your parent. Telling a parent to "act more disabled" backfires and can undermine credibility. Instead, let the nurse see the reality. If your parent usually needs help getting out of the shower, do not help them get dressed and presentable before the nurse arrives.

Schedule the assessment for a difficult time of day. If your parent sundowns (worsens in the late afternoon), request an afternoon assessment. If mornings are hardest, schedule early.

What Happens After

If the OCCO nurse certifies NFLOC, the authorization enters the New Jersey Medicaid Management Information System (NJMMIS). Combined with financial approval from the County Welfare Agency, this triggers MCO enrollment and the care plan assessment. Timeline: 15 to 30 days from the CWA referral to the clinical screening.

If NFLOC is denied, you have the right to appeal. Request a State Fair Hearing through the Division of Medical Assistance and Health Services. Bring the daily care log and any supporting medical documentation that was not available during the initial assessment.

The New Jersey Home Care Guide includes a pre-assessment preparation checklist and a daily care log template designed specifically for NFLOC evaluations.

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