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Long-term care
Some people need extra care. We’ll work closely with you to get you the care you need to live your best life.
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Find out if you or a loved one qualifies
Just call MLTSS care management at 1-833-346-0122 (TTY: 711).
Managed long-term services and supports (MLTSS)
Managed long-term services and supports (MLTSS)
MLTSS helps seniors and people with disabilities live at home for as long as they can. This program uses health plans to arrange support services based on a person’s needs.
Who can enroll in MLTSS?
Who can enroll in MLTSS?
Do you live in New Jersey and meet the state’s criteria for needing a higher level of care? If yes, you may qualify for MLTSS. You can get MLTSS benefits from the comfort of your home or assisted living center. You don’t need to live in a nursing or other facility.
Cost share and liability
Do you live in an assisted living, nursing facility or adult family care setting? If yes, you may need to pay room and board charges to the service provider. The state determines these costs. Some members may also have to pay a cost share, which your county welfare agency determines.
If you qualify for MLTSS benefits, you may be able to get these services:
- Adult family care
- Assisted living services (at home or a facility)
- Assisted Living Program (ALP)
- Traumatic brain injury (TBI) behavioral management (group and individual)
- Caregiver/participant training
- Chore services
- Cognitive therapy (group and individual)
- Community residential services (CRS)
- Community transition services
- Home-based supportive care
- Home-delivered meals
- Medication-dispensing device (set-up and monitoring)
- Mental health and addiction services
- Nursing facility services
- Occupational therapy (group and individual)
- Personal emergency response system (PERS) (set-up and monitoring)
- Physical therapy (group and individual)
- Private duty nursing (adult)
- Changes to your home (home modification)
- Respite (daily and hourly)
- Social adult day care
- Speech, language and hearing therapy (group and individual)
- Structured day program
- Supported day services
- Changes to your car (vehicle modification)
Duals (Medicare and Medicaid) coverage
Your enrollment in our health plan won’t affect your Medicare medical benefits. If you have Medicare coverage, don’t cancel it. Medicare can still cover your provider visits, lab and pharmacy services, and hospital stays.
You may still have some Medicare copays and deductibles, even after you enroll with us. Unless already covered by Medicare, we’ll cover these services when they’re medically necessary:
- Medicare nursing home copays for days 21–100
- Durable medical equipment copays
- Any Medicare copay or deductible that applies to a covered benefit
You’ll also need to pay any Medicare copays or deductibles for noncovered benefits. The New Jersey Division of Medical Assistance and Health Services (DMAHS) offers more info about copays. When you have Medicaid and other insurance (PDF) is a guide to health insurance in New Jersey.
Your care manager
Your care manager
If you qualify, you’ll get an Aetna® care manager, who’ll visit you in person. They’ll work with you, your providers, friends and your family to review your health care needs. You can call your care manager any time for help or to schedule a face-to-face visit. Your family and friends can also be there when your care manager visits.
During the COVID-19 pandemic, your care manager will work with you over the phone instead of in person.
Money Follows the Person (MFP)
Money Follows the Person (MFP)
MFP (also known as I Choose Home NJ) is a program that can help you move from a long-term care facility (nursing home or state hospital) to a house setting in the community, like:
- A home that you or your family owns or leases
- An apartment with an individual lease that includes living, sleeping, bathing and cooking areas
- A home where four or fewer unrelated people live (such as adult family care or shared apartment)
To take part, you must:
- Have lived in a long-term care facility for at least 60 days (includes Medicare rehabilitation time)
- Be eligible for both Medicaid and MLTSS before discharge
- Have health needs that community services can meet
- Sign a consent form that says you want to take part
The MFP program provides:
- Info to help you make an informed choice about the transition and taking part
- Transition support and help in arranging community services
- Care management, with regular phone calls and visits to make sure your move went well and your needs are being met
- Help finding a place to live and arranging for medical, rehabilitative, home health or other community services
Learn more about MTLSS
You can get more info about MLTSS from the state of New Jersey:
You can also contact MLTSS care management. Just call 1-833-346-0122 (TTY: 711).