Department of Human Services | Medicaid Managed Long Term Services and Supports (MLTSS) – NJ.gov
Medicaid Managed Long Term Services and Supports (MLTSS)
What is MLTSS?
Managed Long Term Services and Supports (MLTSS) refers to the delivery of long-term services and supports through New Jersey Medicaid’s NJ FamilyCare managed care program. MLTSS is designed to expand home and community-based services, promote community inclusion and ensure quality and efficiency.
MLTSS uses NJ FamilyCare managed care organizations (also known as HMOs or health plans) to coordinate ALL services. MLTSS provides comprehensive services and supports, whether at home, in an assisted living facility, in community residential services, or in a nursing home.
What does MLTSS cover?
Managed Long Term Services and Supports (MLTSS) includes:
- Access to all NJ FamilyCare Plan A Benefits;
- Care Management;
- Home and Vehicle Modifications;
- Home Delivered Meals;
- Respite;
- Personal Emergency Response Systems;
- Mental Health and Addiction Services;
- Assisted Living;
- Community Residential Services;
- Nursing Home Care.
How is Nursing Home Care covered in MLTSS?
Any individual with NJ FamilyCare entering a nursing facility (NF) or special care nursing facility (SCNF) for the first time will have their acute and primary health care managed by the NJ FamilyCare Managed Care Organizations (MCOs). Short-term Rehabilitation stay in a NF/SCNF is a NJ FamilyCare Plan A benefit. Once the individual has completed rehabilitation, the MCO will screen their member to evaluate if they meet the MLTSS criteria. If the MLTSS criteria are met and the individual requires long-term custodial care in the nursing facility or community, a clinical assessment for MLTSS will be conducted by the MCOs and a determination of clinical eligibility will be made through the Division of Aging Services (DoAS).
Any individual who is pending or newly eligible for NJ FamilyCare Plan A and is living in, or requesting placement, in a NF/SCNF will be referred to the DoAS Office of Community Options (OCCO) for MLTSS clinical eligibility assessment. If the individual is approved both financially and clinically for Medicaid, the individual will be enrolled in MLTSS and in an MCO.
NF/SCNF residents who were considered custodial care on Medicaid prior to July 1, 2014 will remain NJ FamilyCare fee-for-service for the duration of their stay.
How to qualify for MLTSS?
An individual 21 and older can qualify for Managed Long Term Services and Supports (MLTSS) by meeting these established Medicaid requirements:
• Financial Requirements: These include monthly income, as well as total liquid assets. For more detailed information on Medicaid financial eligibility, click here.
• Clinical Requirements:
- An individual 21 years and older meets the clinical eligibility for Nursing Facility level of care, which means the individual requires hands on assistance with three or more activities of daily living such as bathing, dressing, toileting, locomotion, transfers, eating, and bed mobility or has cognitive deficits and requires supervision and cueing with three or more activities of daily living.
- Children ages birth through 20 meet clinical eligibility for MLTSS through functional limitations, identified in terms of developmental delay or functional limitations for age-appropriate activities of daily living, and require nursing care over and above routine parenting and meets the criteria for skilled nursing care that requires complex skilled nursing interventions 24 hours per day, seven days a week.
- Or, have functional limitations, identified in terms of developmental delay or functional limitations for age-appropriate activities of daily living, and require nursing care over and above routine parenting and meets the criteria for medical and/or intense therapeutic services for the technology dependent child who requires a medical device that the Federal food and Drug Administration has classified as a life-supporting or life-sustaining device that is essential to or that yields information that is essential to the restoration continuation of bodily function and continuation of human life and the use of the device requires ongoing skilled nursing intervention 24 hours per day seven days a week.
An individual age 20 or younger can qualify for Managed Long Term Services and Supports (MLTSS) by meeting these established Medicaid requirements:
Note: For children applying for MLTSS, and who meet Pediatric Clinical Eligibility as per the Comprehensive Waiver approved August 2017, parental income and resources are not counted in determining financial eligibility.
• Children ages birth through 20 meet clinical eligibility for MLTSS through functional limitations, identified in terms of developmental delay or functional limitations for age-appropriate activities of daily living, and require nursing care over and above routine parenting and meets the criteria for skilled nursing care that requires complex skilled nursing interventions 24 hours per day, seven days a week.
- Or, have functional limitations, identified in terms of developmental delay or functional limitations for age-appropriate activities of daily living, and require nursing care over and above routine parenting and meets the criteria for medical and/or intense therapeutic services for the technology dependent child who requires a medical device that the Federal food and Drug Administration has classified as a life-supporting or life-sustaining device that is essential to or that yields information that is essential to the restoration continuation of bodily function and continuation of human life and the use of the device requires ongoing skilled nursing intervention 24 hours per day seven days a week.
Age and/or Disability Requirements: These involve age requirements whereby one must be 65 years or older; and/or disability requirements whereby one must be under 65 years of age and determined to be blind or disabled by the Social Security Administration or the State of New Jersey.
How to apply for MLTSS?
For individuals 21 and older contact your local County Area Agency on Aging (AAA) – Aging and Disability Resource Connection (ADRC) to find out more information on services and resources in your area and to be clinically screened for MLTSS.
For children birth through 20 years old contact the Division of Disabilities Services (DDS) at 1-888-285-3036 (press 2 after prompt and then press 1 after next prompt) to speak with an Information and Referral Specialist.
There is another option known as the Program of All-Inclusive Care for the Elderly (PACE) program. To be eligible to enroll, you must live in the PACE provider service area. There currently are six PACE organizations serving parts of ten counties. Click here for more information about PACE.