Managed Long Term Services and Supports (MLTSS)

Some plan members are eligible for MLTSS. To qualify for MLTSS, you must meet the state’s criteria for needing an institutional level of care, as well as meet certain financial requirements. You do not need to reside in a nursing facility or some other institutional facility to get MLTSS. You can get these services in your home or assisted living facility.

The State of New Jersey, Department of Human Services, Division of Medical Assistance and Health Services, offers more MLTSS information to consumers and providers on their Medicaid Managed Long Term Services and Supports website. There is also a Getting Help at Home site with programs and helpful phone numbers. And a New Jersey Senior Services site with more useful information

If you qualify for MLTSS benefits, you may be eligible for these services: 

  • Adult family care
  • Assisted living services
    • Assisted living residence
    • Comprehensive personal care at home
  • Assisted Living Program (ALP)
  • 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: includes set-up and monthly 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)
  • Residential modifications
  • Respite (daily and hourly)
  • Social adult day care
  • Speech, language and hearing therapy (group and individual)
  • Structured day program
  • Supported day services
  • Vehicle modifications

Your enrollment in our health plan won’t affect your Medicare medical benefits. You can still have your doctor visits, laboratory, pharmacy, and hospitalizations covered by Medicare.

If you have Medicare coverage, you should not cancel it. You may still have some Medicare co‑pays and deductibles even after you enroll with us. Unless already covered by Medicare, we will cover the following services when medically necessary:

  • Medicare nursing home co‑pays for days 21‑100
  • Durable medical equipment co‑pays
  • Any Medicare co‑pay or deductible applicable to a covered benefit

You still have to pay any Medicare co‑pays or deductibles for non‑covered benefits.

The New Jersey Division of Medical Assistance and Health Services (DMAHS) offers more information about co-pays including a Medicaid TPL (Third Party Liability) Guide.