A Lifeline for New Jerseyans: The Significance of Defending and Increasing NJ FamilyCare Dwelling and Group-Primarily based Companies

This useful resource was co-created with Incapacity Rights New Jersey and The Boggs Middle on Incapacity and Human Improvement.

Introduction

Most New Jerseyans need to age of their properties and communities, moderately than in institutional settings like nursing services. To stay dwelling at dwelling and energetic of their communities, many individuals need assistance with private care and different help.

Medicaid, not Medicare, is the primary payer for all these helps, generally known as Dwelling and Group-Primarily based Companies (HCBS). In New Jersey, NJ FamilyCare helps almost 90,000 older adults and other people with disabilities dwelling locally by means of its HCBS applications.^[1]

The supply and extent of HCBS protection, nevertheless, may be unsure. It is because beneath federal regulation, states have the choice to supply these companies, however they aren’t required to take action. In consequence, throughout price range shortfalls, whether or not brought on by federal Medicaid funding cuts, a recession, or different monetary challenges, states often take into account lowering elective advantages like HCBS to steadiness their budgets.

This truth sheet supplies an summary of HCBS in New Jersey and their important position in supporting the well being and well-being of older adults and disabled individuals, and makes the case for why New Jersey should decide to sustaining and increasing these important helps despite federal and different fiscal threats.

What are Dwelling and Group-Primarily based Companies?

Medicaid-covered HCBS are companies that assist older adults and other people with disabilities with actions of each day dwelling in settings of their selection, together with personal properties, assisted dwelling services, group properties, and grownup day facilities.

Helps embody, for instance, private care help, care coordination, medically-tailored vitamin, transportation, treatment administration, and residential modifications. New Jerseyans can entry HCBS through varied NJ FamilyCare Medicaid pathways, a few of that are described beneath:

NJ FamilyCare’s Aged, Blind, and Disabled Applications: SSI, MEDICAID ONLY, AND NJ CARE

People who obtain federal Supplemental Safety Revenue (SSI) are robotically eligible for enrollment in NJ FamilyCare. Individuals who may in any other case be eligible for SSI, in the event that they utilized, may apply only for Medicaid and if they’re decided aged, blind, or disabled and have earnings and assets at or beneath the SSI limits, can enroll within the Medicaid Solely pathway.

For each of those enrollment choices, people dwelling in their very own family will need to have a month-to-month earnings as much as $988.25 in 2025 and assets at or beneath $2,000 (for a person). Word: a person beforehand on SSI who receives a spinoff SSA profit from a guardian may be eligible beneath Medicaid Solely by means of the federal “Disabled Grownup Little one” program.

Older adults and other people with disabilities may qualify for Medicaid by means of the NJ Care pathway if they’re aged, blind, or disabled, have earnings as much as 100% of the federal poverty stage ($1,305 per thirty days for a person in 2025) and have assets at or beneath $4,000 for a person.

Underneath these eligibility pathways, lined companies embody medical advantages, in addition to three HCBS advantages by means of New Jersey’s state plan: dwelling well being care, Medical Day Care (grownup day well being companies) and the Private Care Assistant (PCA) profit that enables people who qualify to obtain help with each day actions, resembling bathing, dressing and family duties.^[3] PCA companies may be self-directed by means of the Private Choice Program (PPP).

NJ WorkAbility

This program permits individuals with disabilities who’re working, and consequently have increased earnings and property than different Medicaid pathways allow, to take care of full Medicaid protection.

Though this program shouldn’t be topic to earnings or asset restrictions, it requires these with incomes over 250% of the federal poverty stage ($3,260 for a person in 2025) to pay a premium.

People enrolled in NJ WorkAbility are eligible to obtain HCBS state plan advantages, in addition to extra intensive long-term care advantages primarily based on scientific want.

NJ FamilyCare MLTSS

Folks needing long-term care companies past state plan advantages can entry helps by means of NJ FamilyCare Managed Lengthy Time period Companies and Helps (MLTSS).

To qualify for MLTSS enrollment in 2025, people should meet scientific eligibility (nursing facility stage of care), have a month-to-month earnings beneath 300% of the federal SSI restrict ($2,829 in 2025 or, for increased incomes, arrange a Certified Revenue Belief), and have assets at or beneath $2,000 for a person.

MLTSS helps with growing older in personal properties, assisted dwelling residencies, group properties, and nursing services. As of July 2025, roughly 72,000 older adults and other people with disabilities had been enrolled in MLTSS and had been receiving long-term care in each nursing properties and HCBS settings, and an extra 931 people had been dwelling in a Medicaid fee-for-service nursing facility.^[4]

DDD Group Care Program and Helps Program

Eligible adults with developmental disabilities obtain supportive companies by means of considered one of two Division of Developmental Disabilities HCBS applications: the Helps Program or Group Care Program (CCP).

These applications present an array of companies obligatory to permit individuals with developmental disabilities to dwell locally. Every of those applications has particular eligibility necessities.

The Helps Program companies can be found to individuals dwelling in unlicensed settings, resembling their very own dwelling or household dwelling, and supplies “Employment/Day Companies” and “Particular person/Household Assist Companies.”

There’s a ready listing for CCP companies. CCP companies can be found to individuals dwelling in both unlicensed or licensed settings and supplies “Employment/Day Companies,” “Particular person/Household Assist Companies,” and “Particular person Companies.”^[5]

How are Medicaid Companies Delivered?

New Jersey’s Medicaid Program, NJ FamilyCare, delivers most companies, together with HCBS Private Care Help, by means of managed care. Somewhat than paying suppliers immediately for every service, the state contracts with personal managed care plans and pays them a set month-to-month quantity to supply companies.

New Jersey presently contracts with 5 managed care organizations: Aetna, Fidelis Care, Horizon NJ Well being, United Healthcare Group Plan, and WellCare of New Jersey.^[6] Notably, some HCBS companies, together with waiver companies out there by means of the DDD, stay “carved out” of managed care, and are nonetheless paid for on a fee-for-service foundation. 

As well as, New Jersey affords specialised supply fashions for particular populations. One possibility, the Program of All-inclusive Take care of the Aged (PACE), is a service supply possibility for individuals age 55 and older who’re eligible for Medicare and/or Medicaid and meet a nursing facility stage of care.

This mannequin supplies companies and socialization at a PACE heart throughout the day, together with HCBS within the enrollee’s personal dwelling. Eight PACE businesses function in New Jersey inside sure zip codes.^[7] As of July 2025, 1,415 people had been enrolled in PACE.^[8]

New Jersey additionally affords a kind of Medicare Benefit plan, generally known as a Absolutely Built-in Twin Eligible Particular Wants Plan (FIDE-SNP), to supply companies to people who find themselves dually eligible for each Medicare and Medicaid. These plans coordinate and canopy an enrollee’s Medicare and Medicaid advantages, together with long-term care advantages. As of July 2025, there are six FIDE-SNPs out there in New Jersey with a complete enrollment of 95,789.^[9]

A New Jersey Snapshot: LTSS Expenditures

When inspecting the entire quantity of spending on Lengthy Time period Companies and Helps (LTSS) expenditures (mixture of each HCBS and nursing facility companies), it seems that New Jersey spends extra on HCBS (67%) than institutionalized care (33%).^[10]

Nonetheless, when spending is damaged out by inhabitants, variations emerge. In 2022, for instance, New Jersey spent 43% of its LTSS expenditures on HCBS and 57% on nursing facility take care of older adults ages 65 and older, suggesting there may be an extra alternative to additional rebalance companies in direction of community-based helps for this inhabitants.^[11]

HCBS are a Lifeline

NJ FamilyCare’s HCBS assist individuals stay of their properties and communities moderately than having to obtain care in an institutional setting, like a nursing facility.

These applications improve high quality of life, promote dignity, and enhance well being outcomes. Additionally they supply crucial assist to household caregivers by means of respite care and paid help, amongst different helps. Merely put, HCBS are a lifeline.

Medicaid HCBS Assist Joan, 92, Dwell Independently at Dwelling

Medicaid HCBS make it doable for Joan to dwell alone in her personal house. Her private care aides help her with actions of each day dwelling, resembling getting away from bed, getting dressed, transferring, cooking, cleansing, and laundry. With out these caregivers, Joan wouldn’t be capable to proceed to dwell independently in her dwelling.

When describing these advantages, Joan states: “MLTSS is so vital in my life as a result of it permits me to stay unbiased in my house. I need to really feel like I’ve management over my very own life as I age—and I’ll be 92 this month—and having an aide by means of Medicaid is essential to sustaining my independence locally I’ve lived in for almost 20 years.”

Wesley, 49, Self-Directs His Private Care Companies to Preserve His Independence

Wesley, who has been blind since beginning, depends on his self-directed private care aides to take care of his independence at dwelling and locally.

“I’m on the PPP which stands for the Private Choice Program the place I can rent my very own private care attendants and never should depend on an company for the mandatory assist companies that I want to remain unbiased. I’m very grateful for a program such because the Private Choice Program which permits me to dwell alone and stay unbiased in my home. With out the mandatory assist companies and with out Medicaid having this program out there to me, I don’t know what I’d do.”

The Penalties of Reducing Dwelling and Group-Primarily based Companies: A Historic Perspective

Historical past demonstrates that when states expertise fiscal uncertainty, they usually resort to reducing HCBS. Such was the case following the 2009 Nice Recession when each state lowered HCBS spending both by reducing advantages or limiting eligibility.^[12]

The implications of reducing HCBS are extreme. Individuals who don’t obtain ample assist usually tend to have issue leaving the home, looking for groceries, and have a better danger of experiencing treatment errors.^[13] For many who want help, the lack of HCBS might go away them no selection however to maneuver right into a expensive establishment to obtain care.

Analysis exhibits, for instance, that individuals 50 years and older who want however don’t obtain HCBS, are almost 5 occasions extra more likely to have a nursing facility keep than individuals who have ample assist. Nationally, this interprets into 3.1 million extra nursing dwelling stays, growing nursing dwelling expenditures, that are 4 occasions costlier than HCBS.^[14]

Cuts to HCBS additionally translate into extra prices for household caregivers. Immediately, roughly 1.1 million New Jerseyans act as a caregiver for a member of the family.^[15] Practically one in 5 expertise important monetary pressure, and almost half (47%) report a minimum of one adverse monetary influence stemming from elevated bills, lowered work hours, or the necessity to go away their job to supply care, disproportionately impacting girls of coloration.^[16]

Moreover, one in 4 caregivers reviews feeling that caregiving has made their well being worse.^[17] Cuts to HCBS would worsen these points, forcing household caregivers to tackle much more duty and jeopardizing their financial safety, well being, and the well-being of these they take care of.

HCBS cuts may negatively have an effect on the almost 137,000 paid caregivers in New Jersey.^[18] Many direct care employees obtain NJ FamilyCare advantages by means of Medicaid enlargement, and new necessities contained in H.R. 1 might place this inhabitants at elevated danger of shedding well being protection. HCBS cuts may pressure HCBS supplier reimbursement charges, limiting suppliers’ potential to put money into their workforce.

These pressures might lead direct care employees to go away the sector for extra secure employment, which might additional exacerbate the direct workforce disaster and make it harder for older adults and other people with disabilities to entry the LTSS they want.

How Can New Jersey Defend and Strengthen Entry to HCBS?

New Jersey has made important progress in increasing entry to HCBS. But, many New Jerseyans who want HCBS are nonetheless unable to get them, and should go with out care, transfer into nursing services, or depend on household caregivers to fill within the gaps.

As a result of about 70% of people that attain age 65 will finally want some long-term care companies, and adults age 65 and older are projected to make up greater than 20% of the state’s inhabitants by the top of the last decade, the variety of New Jersey residents needing long-term care will develop considerably because the inhabitants ages.^[19]

Federal cuts to Medicaid and different fiscal uncertainties threaten the HCBS applications that older adults and other people with disabilities rely upon to dwell of their properties and communities as they age.

New Jersey might want to discover sustainable methods to guard HCBS throughout fiscal uncertainty whereas concurrently increasing entry to those important companies by:

• Rising income for NJ FamilyCare to guard and develop entry for New Jersey’s growing older and incapacity populations and to fill protection gaps.
• Increasing NJ FamilyCare monetary eligibility standards, each earnings and asset thresholds, for Medicaid pathways impacting older adults and other people with disabilities.^[20]
• Constructing and supporting an ample statewide community of HCBS suppliers and direct care employees.
• Defending enhanced eligibility pathways, resembling NJ WorkAbility, that allow individuals to work and preserve their Medicaid protection.

Conclusion

HCBS are important for enabling older adults and other people with disabilities to dwell with dignity in their very own properties and communities. Policymakers might want to prioritize methods to extend income, and safeguard the progress New Jersey has made in increasing HCBS availability, whereas additionally implementing insurance policies that additional improve and enhance entry to those crucial helps.

Endnotes

1. Group Dwelling Fairness Middle, Who Receives Medicaid LTSS?, out there at https://heller.brandeis.edu/community-living-policy/clec/who-receives-medicaid-ltss.html. ↑

2. Backyard State Coalition for Care, out there at https://disabilityrightsnj.org/gscc/. ↑

3. New Jersey Division of Human Companies, Division of Incapacity Companies, Private Care Assistant (PCA) Companies, out there at https://www.nj.gov/humanservices/dds/hottopics/personalcare/. ↑

4. NJ FamilyCare, Lengthy Time period Care: Month at a Look, out there at https://njfamilycare.dhs.state.nj.us/analytics/LTC_explorer.html. ↑

5. New Jersey Division of Human Companies, Division of Developmental Disabilities, “A Fast Information for Households,” out there at https://www.nj.gov/humanservices/ddd/property/paperwork/quick-guide-for-families-english.pdf.↑

6. New Jersey Division of Human Companies, Division of Medical Help and Well being Companies, NJ FamilyCare Well being Plans, out there at https://www.nj.gov/humanservices/dmahs/purchasers/medicaid/hmo/. ↑

7. New Jersey Division of Human Companies Division of Ageing Companies, Program for All-inclusive Take care of the Aged (PACE), out there at https://www.nj.gov/humanservices/doas/companies/l-p/tempo/. ↑

8. NJ FamilyCare, Lengthy Time period Care: Month at a Look, out there at https://njfamilycare.dhs.state.nj.us/analytics/LTC_explorer.html. ↑

9. Facilities for Medicare & Medicaid Companies, “SNP Complete Report July 2025,” out there at https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/special-needs-plan-snp-data/snp-comprehensive-report-2025-07. ↑

10. Medicaid.gov, Reviews & Evaluations: 2022 Lengthy Time period Companies and Helps Customers and Expenditures, out there at https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations. ↑

11. Ibid. ↑

12. Well being Affairs, Historical past Repeats? “Confronted with Medicaid Cuts, States Decreased Assist for Older Adults and Disabled Folks,” out there at https://www.healthaffairs.org/content material/forefront/history-repeats-faced-medicaid-cuts-states-reduced-support-older-adults-and-disabled. ↑

13. UCLA Middle for Well being Coverage Analysis, “Unmet Wants for Assist at Dwelling: How Older Adults and Adults with Disabilities Are Going through in California,” out there at https://healthpolicy.ucla.edu/websites/default/information/legacy/Paperwork/PDF/2022/Unmet-Wants-for-Assist-at-Dwelling-factsheet-aug2022.pdf. ↑

14. LeadingAge LTSS Middle UMass Boston, “Influence of HCBS on Nursing Dwelling use and Influence of HCBS Cutbacks on Beneficiaries dwelling within the Group at a Nursing Dwelling Stage of Care,” out there at https://www.ltsscenter.org/wp-content/uploads/2025/04/Influence-of-HCBS-Cutbacks-on-Nursing-Dwelling-Care-Utilization-April-2025.pdf. ↑

15. AARP Public Coverage Institute, “Valuing the Invaluable: 2023 Replace Strengthening Helps for Household Caregivers,” out there at https://infogram.com/economic-value-of-family-caregiving-by-state-2023-1hzj4o379jn034p. ↑

16. AARP and NAC, “Caregiving within the US Analysis Report,” out there at https://caregivingkinetics.com/wp-content/uploads/2025/08/AARP-NAC-caregiving-in-us-2025.doi_.10.26419-2fppi.00373.001.pdf. ↑

17. Innovation Ageing, “Caregiver Well being and Nicely-Being, and Monetary Pressure,” out there at https://pmc.ncbi.nlm.nih.gov/articles/PMC7743788/. ↑

18. PHI, “Workforce Information Middle,” out there at https://www.phinational.org/policy-research/workforce-data-center/#states=34&var=Employment+Developments. ↑

19. U.S. Division of Well being and Human Companies, “Caregiver Assets & Lengthy-Time period Care,” out there at https://www.hhs.gov/growing older/long-term-care/index.html; New Jersey Division of Human Companies, Division of Ageing Companies, “Age-Pleasant Assets: What’s Age-Pleasant?,“ out there at https://www.nj.gov/humanservices/doas/assets/age-friendly/. ↑

20. Justice in Ageing, Medicaid Cliff Doc, out there at https://justiceinaging.org/wp-content/uploads/2024/09/Medicaid-Cliff-NJ-Infographic.pdf. ↑