NJ FamilyCare MLTSS Application Process
What MLTSS Covers
New Jersey's Managed Long Term Services and Supports program funds nursing home care, assisted living services, and intensive home-based care for individuals who need help with daily activities but cannot afford to pay privately. It is the Medicaid pathway for long-term care in New Jersey — administered through NJ FamilyCare Managed Care Organizations.
MLTSS covers nursing facility placement, personal care assistants, adult day health, home-delivered meals, respite care, home modifications, and the Personal Preference Program (which allows beneficiaries to hire family members as paid caregivers). It does not cover room and board in assisted living — only the care services.
Getting in requires clearing two gates.
Gate One: The Clinical Assessment
Before MLTSS will pay for anything, your parent must demonstrate a Nursing Facility Level of Care (NFLOC). The clinical standard requires functional deficits requiring hands-on assistance with three or more activities of daily living (bathing, dressing, toileting, transferring, eating) — or severe cognitive impairment requiring constant supervision.
How the clinical assessment happens depends on where your parent is:
In the hospital: The hospital discharge planner completes an Enhanced At-Risk Criteria (EARC) screening for a patient expected to transfer to an SNF when Medicaid may pay for some or all of the stay. EARC is for patients who are Medicaid-eligible but not yet enrolled in an MCO, or who are expected to spend down and become eligible within 180 days. It provides a fast-track 90-day clinical authorization and is valid for 10 days after determination — the transfer must happen within that window.
In the community: Contact the county Aging and Disability Resource Connection (ADRC) or the statewide toll-free line at 1-877-222-3737. The ADRC arranges an in-person assessment by the Office of Community Choice Options (OCCO). An OCCO clinician evaluates your parent using the NJ Choice tool, which measures functional, medical, and cognitive deficits.
Already in an MCO: If your parent is already enrolled in an NJ FamilyCare MCO (Horizon NJ Health, Aetna Better Health, UnitedHealthcare Community Plan), the hospital bypasses EARC and requests prior authorization directly from the MCO's care management team.
Gate Two: The Financial Review
The financial eligibility review is conducted by the County Board of Social Services (also called the County Welfare Agency) in your parent's county of residence.
The 2026 limits:
| Criteria | Single Applicant | Married (One Applying) |
|---|---|---|
| Gross monthly income cap | $2,982 | $2,982 (applicant only) |
| Countable asset limit | $2,000 | $2,000 (applicant) + CSRA for spouse |
| Home equity exemption | $1,130,000 | Exempt if spouse lives there |
If your parent's gross monthly income exceeds $2,982 from any source — Social Security, pensions, IRA distributions — they are disqualified unless they establish a Qualified Income Trust (QIT). The QIT is an irrevocable trust with a dedicated bank account. Each month, all income above the cap must be deposited into the trust account, then disbursed only for approved expenses in a specific order.
The financial review also includes a 60-month look-back. The county examines five years of bank statements, asset transfers, and property transactions looking for gifts or below-market-value transfers that might have been made to artificially reduce assets. Transfers that violate the look-back trigger a penalty period during which MLTSS will not pay for care.
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The Application Itself
Submit the NJ FamilyCare Long-Term Care application to the County Board of Social Services in your parent's county of residence, including when your parent is already in a nursing home.
You will need to provide:
- Proof of identity and citizenship or immigration status
- Social Security card and Medicare card
- Five years of bank statements for all accounts
- Tax returns for the look-back period
- Proof of all income sources (Social Security award letter, pension statements, IRA distributions)
- Deed and mortgage documents for any real property
- Life insurance policies with cash value documentation
- Vehicle titles
- Burial/funeral contracts
- Documentation of any asset transfers in the past 60 months
The county caseworker reviews the financial packet and may request additional documentation. Respond to every request promptly — delays in providing documents extend the processing time and can result in a lapsed application, which weakens eviction protections if your parent is already in a facility.
MCO Assignment and Care Coordination
Once both the clinical and financial gates are cleared, your parent is enrolled in MLTSS through one of New Jersey's participating MCOs. If they are not already in an MCO, they will be assigned one — though they can request a specific plan.
The MCO assigns a care coordinator who develops a person-centered service plan. This plan specifies which services your parent will receive, how many hours of personal care assistance they are authorized for, and which providers will deliver the care.
If you disagree with the service plan — for example, the authorized hours are insufficient — you have the right to appeal through the MCO's internal grievance process and, beyond that, to request a fair hearing with the state.
The Hospital-to-Home in New Jersey guide includes the five-year document organizer, the QIT setup walkthrough, and the county-by-county contact directory for every Board of Social Services in New Jersey.
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