A campaign is underway to urge lawmakers to make New Jersey’s Medicaid program more equitable and enable more older adults and residents with disabilities to receive the care they need in less-restrictive and less-costly home and community settings.
A robust group of aging and disability stakeholders from around the state formed a coalition last fall to address the injustice of people over 65 and individuals with disabilities being subject to more stringent Medicaid eligibility criteria than younger populations.
“People shouldn’t lose coverage for essential health services simply because they turn a day older, but that is what can happen under current Medicaid policies,” said Hannah Diamond,
Policy Advocate at Justice in Aging, a nonprofit organization that advocates for an end to senior poverty.
Justice in Aging, New Jersey Advocates for Aging Well, and some of New Jersey’s leading aging and disability advocacy organizations, such as AARP New Jersey, Disability Rights New Jersey, Leading Age New Jersey & Delaware, and Legal Services of New Jerseyare helping to steer the new coalition.
The advocates are hoping to win support for legislation introduced in June that could offer a remedy: Assembly Bill 4612seeks to make two significant fixes to Medicaid programs serving low-income older adults and individuals with disabilities.
The first fix would raise the income-eligibility limit for several Medicaid programs to 138 percent of the federal poverty line – putting those programs in line with criteria set for people under age 65 who are eligible for Medicaid under the Affordable Care Act program expansion.
The second fix would increase the asset limit for those programs. Current Medicaid policies force older adults and individuals with disabilities to “spend down” what limited money they have in the bank and liquidate other assets to reach what many consider unreasonably low thresholds to qualify for Medicaid.
The asset limits differ across several Medicaid programs. One of the most stringent is the limit set for the Managed Long-Term Services and Supports (MLTSS) program, which requires an individual to have assets of no more than $2,000. This program is particularly important to older adults and people with disabilities, as it enables recipients to receive critical home care services and remain living in independent settings instead of nursing homes.
That $2,000 asset limit – originally set in 1989 when most long-term-care was delivered in nursing homes or institutional settings – doesn’t account for the unexpected or emergency costs an older renter or homeowner could face when receiving care in the community.
“Someone living in the community wants the security of knowing they have enough money in the bank to cover emergencies or common expenses like home or car repairs,” Diamond said.
The low asset limit has a disproportionate burden on residents of color, who are more likely to be renters and who might face sharp rent hikes or need to have deposit money on hand for a new apartment if they have to move, advocates point out.
People of color are also more likely to be dually eligible for both Medicare and Medicaid, another population segment that is negatively impacted by the more restrictive eligibility criteria. In comparison to Medicare-only recipients, federal data shows that people dually eligible for both programs are more likely to self-report being in poor health and need assistance with daily activities, making their need for medical assistance and home care support even more critical.
The proposed legislation would raise the asset limit for several Medicaid programs serving older and disabled adults to $40,000 – the limit set for the Jersey Assistance for Community Caregiving (JACC) program. Raising the asset threshold – together with the raised income limit – would put an end to what Justice in Aging and other advocacy groups dub the Medicaid
eligibility “cliff.”
While advocates are encouraged by the introduction of A-4612, the Legislature is recessed for the summer and hearings on the bill cannot take place until later this year or early next. In the interim, the coalition hopes to engage more allies in advocating for the eligibility changes.
The coalition is asking individuals, family caregivers and provider organizations to assist in an effort to collect stories of individuals who have been negatively impacted by stringent Medicaid eligibility thresholds. Examples being sought include those who have lost coverage after turning 65, those who decided to forego Medicaid enrollment for fear of depleting their assets or those now facing the stress of living in poverty after spending down to qualify.
The stories are being collected at this link.
The examples shared will be used to help decisionmakers – and the populace at large – better understand why New Jersey’s Medicaid program lags behind 34 other states in the percentage of dollars going to care offered in home and community settings. According to a 2022 issue brief published by Justice in Aging, 79% of New Jersey’s Medicaid spending for older adults and people with physical disabilities was going to institutional care, which costs more than care delivered in home or community settings.
“Medicaid recipients, advocates, and providers have shared heartbreaking examples of individuals losing access to critical Medicaid benefits as a result of these inequitable income and resource thresholds,” Diamond said. “This puts them at risk of serious health problems, which could lead to unnecessary and costly emergency room visits or nursing facility admissions.”
Coalition members argue that increasing access to Medicaid-funded home and community- based care will save New Jersey the higher costs incurred by those needless hospitalizations and longer nursing home stays. In addition, streamlining eligibility would make the enrollment process less cumbersome – not just for individuals, but also for state administrators.
Justice in Aging, with the support of a 3-year-grant from The Henry & Marilyn Taub Foundation, has produced a number of informational materials to explain the current inequities in the Medicaid system.
Here are some valuable print and video resources for anyone seeking to learn more:
- 22 Recommendations to Improve Equitable Access to HCBS in NJ
- Raising the Medicaid Income Limits for Older Adults and People with Disabilities
- Raising New Jersey’s Medicaid Asset Limits for Older Adults & People with Disabilities
- RVN Television: Advocating for the Aging with Hannah Diamond
In addition, anyone seeking to join the coalition or receive email updates about this advocacy campaign should contact Hannah Diamond at [email protected]