Glossary of Terms Used in NJ Medicaid

Vocabulary words have meaning both in life and in the law. Below I have listed the most frequent terms used in this website and what each word means. The terms are listed in alphabetical order. I am certain this glossary will be of assistance to you in your reading.

  • Caregiver – A caregiver is anyone who helps care for an elderly individual or person with disability who lives at home.   Caregivers usually provide assistance with activities of daily living and other essential activities like shopping, meal preparation and housework.
  • Chronically Ill – Having a long lasting or recurrent illness or condition that causes you to need help with activities of daily living and often other health and support services.   The condition is expected to last for a least 90 consecutive days.  The term used in tax-qualified long term care insurance policies to describe a person who needs long term care because of an inability to do a certain number of activities of daily living without help, or because of a severe cognitive impairment such as Alzheimer’s Disease.
  • Cognitive Impairment – Deficiency in short or long term memory, orientation in person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.  Alzheimer’s Disease is an example of cognitive impairment.
  • Community Spouse – Spouse of a nursing home resident applying for or receiving Medicaid long term care services.
  • Community Based Services – Services and service settings in the community such as adult day services, home delivered meals, or transportation services.   Often referred to as home and community based services, they are designed to help older people and people with disabilities stay in their homes as independently as possible.
  • Continuing Care Retirement Communities – A retirement community or building that offers a range of services and levels of care.  Residents may move first into an independent living unit, a private apartment, or a house on the campus.  The CCRC provides social and housing related services and often also has an assisted living unit and an onsite or affiliated nursing home.  If and when residents can no longer live independently in their apartment or home, they move into an assisted living or the CCRC’s nursing home.
  • Custodial Care – (also called personal care)   Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
  • Do Not Resuscitate Order (DNR) – Written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest.  A DNR order may be instituted on the basis of an Advance Directive from a person, or from someone entitled to make decisions on the person’s behalf, such as a healthcare proxy.  In some jurisdictions, such order can also be instituted on the basis of a physician’s own initiative, unusually when resuscitation would not alter the ultimate outcome of a disease.  Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR orders are more common when a person with a fatal illness wishes to die without painful or invasive medical procedures.
  • Elimination Period Under Long Term Care Policy – (also known as Deductible Period or Benefit Waiting Period) Specified amount of time at the beginning of a disability during which you receive covered services, but the policy does not pay benefits.  A Service Day Deductible Period is satisfied by each day of the period in which you receive covered services.   A Calendar Day or Disability Day Deductible Period doesn’t require that you receive covered services during the entire deductible period, but only requires that you meet the policy’s benefit triggers during that time period.
  • Estate Recovery – Process by which Medicaid recovers an amount of money from the estate of the person who received Medicaid.   The amount Medicaid recovers cannot be greater than the amount it contributed to the person’s medical care.
  • Exempt Assets – (also called Non-Countable Assets) Assets whose value is not counted in determining financial eligibility by Medicaid.  They include:
    • Personal belongings
    • One Vehicle
    • Life Insurance with a face value under $1,500.00

    Your home provided that your spouse or child lives there and its equity value is less than $500,000 ($750,000 in some states).

  • Financial Eligibility – Assessment of person’s available income and assets to determine if he or she meets Medicaid eligibility requirements.
  • Functional Eligibility – Assessment of a person’s care needs to determine if he or she meets Medicaid eligibility requirements for payment of long-term care services.   The assessment may include a person’s ability to perform activities of daily living or the need for skilled care.
  • General Medicaid Eligibility Requirements – You must be:
    • A resident of the state in which you are applying
    • Either a United States citizen or legally admitted alien
    • Age 65 or over
    • Or meet Medicaid’s rules for disability or blind
  • Group Home (also called Board and Care Home) Residential private homes designed to provide housing, meals, housekeeping, personal care services, and supports to persons with a disability or other frail residents.  At least one caregiver is onsite at all times.  In many states, group homes are licensed or certified and must meet criteria for facility safety, types of services provided, and the number and type of residents they can care for.  Group homes are often owned and managed by an individual or family involved in their everyday operation.
  • Healthcare Proxy – legal document in which you name someone to make healthcare decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
  • Hospice Care – Short term, supportive care for individuals who are terminally ill (have a life expectancy of six months or less)   Hospice care focuses on pain management and emotional, physical, and spiritual support for the patient and family.   It can be provided at home or in a hospital, nursing home, or hospice facility.   Medicare typically pays for hospice care.  Hospice care is not usually considered long term care.
  • Instrumental Activities of Daily Living – Activities that are not necessary for basic functioning but are necessary in order to live independently.  The activities may include:
    • Doing light housework
    • Preparing and cleaning up after meals
    • Taking medication
    • Shopping for groceries or clothes
    • Using the telephone
    • Managing money
    • Taking care of pets
    • Using communication devices
    • Getting around the community
    • Responding to emergency alerts such as fire alarms
  • Long-Term Care – Services and supports necessary to meet health and personal care needs over an extended period of time.
  • Long–Term Care Facility – (also called Long Nursing Home or Convalescent Care Facility) Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
  • Long-Term Care Insurance – Insurance policy designed to offer financial support to pay for long term care services.
  • Long-Term Care Services –  Services that include medical and non-medical care for people with chronic illness or disability.   Long-term care helps meet health and personal needs.   Most long-term care services assist people with activities of daily living, such as dressing, bathing and using the bathroom.  Long-term care can be provided at home, in the community, or in a facility.  For purposes of Medicaid eligibility and payment, long term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.
  • Look Back Period – Five year period prior to a person’s application for Medicaid payment of long term care services.   The Medicaid agency determines if any transfers of assets have taken place during that period that would disqualify the applicant from receiving Medicaid benefits for a period of time called the penalty period.
  • Medicaid – Joint federal and state public assistance program for financing health care for low income people.  It pays for health care services for those with low incomes or very high medical bills relative to income and assets.  It is the largest public payer of long term care services.
  • Medical Power of Attorney – Legal document that allows you to name someone to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions for yourself.
  • Medicare – Federal program that provides hospital and medical expense benefits for people over age 65, or those meeting specific disability standards.  Benefits for nursing home and home health services are limited.
  • Non-Countable Assets  – (also called exempt assets)   Assets whose value is not counted in determining financial eligibility for Medicaid.  They include:
    • Personal belongings
    • One vehicle
    • Life insurance with a face value under $1,500.00
    • Your home provided that your spouse or child lives there and its equity value is less than $500,000.00 ($750,000.00 in some states)
  • Nursing Home  – (also called Long Term Care Facility or Convalescent Care Facility)   Licensed facility that provides general nursing care to those who are chronically ill or unable to take care of daily living needs.
  • Person with a Disability – For Medicaid eligibility purposes, a person with a disability is someone whose physical or mental condition prevents him or her from doing enough work or the type of work needed for self-support.   The condition must be expected to last for a least a year or be expected to result in death.  Persons receiving disability benefits through Supplemental Security Income (SSI, Social Security, or Medicare automatically meet this criteria.
  • Personal Care – (Also called custodial care) Non-skilled service or care, such as help with bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom.
  • Respite Care – Temporary care which is intended to provide time off for those who care for someone on a regular basis.  Respite care is typically 14 to 21 days of care per year and can be provided in a nursing home, adult day service center, or at home by a private party.
  • Reverse Mortgage – Type of loan based on home equity that enables older homeowners (age 62 or older) to convert part of their equity in their home into tax-free income without having to sell the home, give up title, or take on a new monthly mortgage payment.  Instead of making monthly payments to a lender, as you do with a regular mortgage, a lender makes payments to you.  The loan, along with financing costs and interest on the loan, does not need to be repaid until the homeowner dies or no longer lives in the home.
  • Skilled Care – Nursing care such as help with medications and caring for wounds and therapies such as occupational, speech, respiratory, and physical therapy.   Skilled care usually requires the services of a licensed professional such as a nurse, doctor or therapist.
  • Skilled Care Needs – Services requiring the supervision and care of a nurse or physician, such as assistance with oxygen, maintenance of a feeding tube, or frequent injections.
  • Spend Down – Requirement that an individual spend down most of his or her income and assets to pay for care before he or she can satisfy Medicaid financial eligibility criteria.
  • Supervisory Care – Long term care service for people with memory or orientation problems.  Supervision ensures that people don’t harm themselves or others because their memory, reasoning and orientation to person, place, or time are impaired.
  • Supplemental Security Income (SSI) ­ – Program administered by the Social Security Administration that provides financial assistance to needy persons with a disability or aged 65 or older.
  • Transfer of Assets – Giving away property for less than it is worth or for the sole purpose of becoming eligible for Medicaid.  Transferring assets during the look back period results in disqualification for Medicaid payment of long term care services for a penalty period.
  • Transferring – Moving in and out of bed, chair or wheelchair.   Transferring is one of the six activities of daily living.

Fredrick P. Niemann Esq.

Have questions about NJ Medicaid? If so, call our office today. Ask for Mr. Niemann to personally discuss your questions and individual situation toll-free at (855) 376-5291 or e-mail him at fniemann@hnlawfirm.com.

 

 

 

 

Written by Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, New Jersey Medicaid Attorney

NJ Medicaid Attorney serving these New Jersey Counties:

Monmouth County, Ocean County, Essex County, Cape May County, Camden County, Mercer County, Middlesex County,
Bergen County, Morris County, Burlington County, Union County, Somerset County, Hudson County, Passaic County