Presumptive Eligibility for Medicaid Home and Community-Based Services 

  • Mar 05, 2024
Governor Murphy signs law allowing for Presumptive Eligibility for Medicaid Home and Community-Based Services 

 

Disability Rights New Jersey has long advocated for individuals to have the supports and services in their own home so that they do not have to be institutionalized in nursing homes.

On January 16th of this year, Governor Murphy signed legislation that will provide greater opportunities for individuals with disabilities to receive those supports and services. Governor Murphy signed legislation that provides for presumptive eligibility for Medicaid home and community-based services for individuals who are likely to be financially and clinically eligible for Medicaid so that these individuals can receive services immediately while their Medicaid application is pending. 

Without presumptive eligibility, many individuals who are hospitalized and awaiting Medicaid eligibility are unable to return to their homes as they are not able to pay for the supports and services that will allow them to return home. Instead, many in this situation end up going to a nursing home, which can provide medical services while Medicaid eligibility is pending and obtain reimbursement once eligibility is determined. With presumptive eligibility, home and community-based providers can begin offering services and supports that allow these individuals to return to their homes, where most individuals wish to be.

The law is conditional on the Department of Human Services obtaining federal approval, and it allows for a 30-month implementation timeframe in order for the Department of Human Services to seek and obtain the necessary federal approvals.

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