Navigating the landscape of long-term care can be complex, especially when seeking support for mental health needs. Many individuals and families are searching for clarity on which programs specifically cover mental health services within long-term care frameworks. This article will delve into Managed Long Term Services and Supports (MLTSS), a crucial program designed to provide comprehensive care, including vital mental health services, within the realm of long-term care.
What is Managed Long Term Services and Supports (MLTSS)?
Managed Long Term Services and Supports (MLTSS) represents an innovative approach to delivering long-term care through managed care programs, specifically within the context of New Jersey Medicaid’s NJ FamilyCare. The core objective of MLTSS is to broaden the availability of home and community-based services, foster greater community inclusion for individuals needing long-term support, and simultaneously ensure both the quality and efficiency of care delivery.
At its heart, MLTSS leverages the network of NJ FamilyCare managed care organizations (MCOs), also known as HMOs or health plans, to orchestrate and coordinate the full spectrum of services required by its participants. Whether an individual receives care in the comfort of their own home, within an assisted living facility, in community residential settings, or even in a nursing home, MLTSS is designed to provide comprehensive and integrated services and supports tailored to their unique needs.
What Services Does MLTSS Cover, Including Mental Health and Addiction Services?
MLTSS is designed to be comprehensive, ensuring participants have access to a wide array of services. Crucially, for those concerned about mental wellness, MLTSS explicitly includes Mental Health and Addiction Services within its coverage. Beyond this vital component, the program encompasses a range of other essential services, including:
- Access to all NJ FamilyCare Plan A Benefits: This foundational access ensures participants receive standard healthcare benefits.
- Care Management: Personalized care coordination to navigate and manage services effectively.
- Home and Vehicle Modifications: Adaptations to living spaces and vehicles to enhance accessibility and independence.
- Home Delivered Meals: Nutritional support delivered directly to the home.
- Respite Care: Temporary relief for caregivers, allowing them to take essential breaks.
- Personal Emergency Response Systems (PERS): Technology to ensure rapid assistance in case of emergencies at home.
- Assisted Living Services: Support for individuals residing in assisted living facilities.
- Community Residential Services: Care within community-based residential settings.
- Nursing Home Care: Coverage for individuals requiring nursing home level of care.
This broad spectrum of services, with the explicit inclusion of mental health and addiction services, demonstrates MLTSS’s commitment to addressing the holistic needs of individuals requiring long-term care.
How Does MLTSS Cover Nursing Home Care and Mental Health Needs?
For individuals entering a nursing facility (NF) or special care nursing facility (SCNF) who are part of NJ FamilyCare, MLTSS ensures their acute and primary healthcare needs are managed by NJ FamilyCare Managed Care Organizations (MCOs). Initially, a short-term rehabilitation stay within a NF/SCNF is covered as a standard NJ FamilyCare Plan A benefit.
Following rehabilitation, the MCO will assess the individual to determine if they meet the criteria for MLTSS. If MLTSS criteria are met and the individual requires ongoing long-term custodial care, whether in the nursing facility or community, a comprehensive clinical assessment for MLTSS is conducted by the MCOs. The Division of Aging Services (DoAS) then makes the final determination regarding clinical eligibility for MLTSS. This process ensures that individuals requiring nursing home care, and potentially mental health services within that setting, are appropriately evaluated and enrolled in MLTSS if eligible.
For individuals already residing in or seeking placement in a NF/SCNF who are pending or newly eligible for NJ FamilyCare Plan A, referral to the DoAS Office of Community Options (OCCO) is made for MLTSS clinical eligibility assessment. Upon approval for both financial and clinical Medicaid eligibility, the individual will be enrolled in MLTSS and an MCO, ensuring access to the program’s comprehensive benefits, including mental health support.
It’s important to note that residents in NF/SCNF who were receiving custodial care under Medicaid prior to July 1, 2014, remain under the NJ FamilyCare fee-for-service system for the duration of their stay.
Who is Eligible for MLTSS and Mental Health Services Coverage?
Eligibility for Managed Long Term Services and Supports (MLTSS) is based on established Medicaid requirements, encompassing both financial and clinical criteria. These requirements differ slightly based on age:
For Individuals 21 and Older:
- Financial Requirements: These consider monthly income and total liquid assets. Detailed information on Medicaid financial eligibility is available here.
- Clinical Requirements:
- Meeting the clinical eligibility for Nursing Facility level of care, defined as requiring hands-on assistance with three or more Activities of Daily Living (ADLs) such as bathing, dressing, toileting, locomotion, transfers, eating, and bed mobility.
- Alternatively, having cognitive deficits necessitating supervision and cueing with three or more ADLs.
For Individuals Age 20 or Younger:
- Clinical Requirements:
- Experiencing functional limitations identified as developmental delays or limitations in age-appropriate ADLs, requiring nursing care beyond routine parenting. This includes meeting criteria for skilled nursing care involving complex interventions 24/7.
- Or, having functional limitations and requiring medical and/or intense therapeutic services as a technology-dependent child needing a life-supporting or life-sustaining medical device. The use of this device must necessitate ongoing skilled nursing intervention 24/7.
Age and/or Disability Requirements (Applicable to both age groups):
- Age 65 or older.
- Under 65 years of age and determined to be blind or disabled by the Social Security Administration or the State of New Jersey.
Important Note for Children: For children applying for MLTSS meeting Pediatric Clinical Eligibility, parental income and resources are not considered when determining financial eligibility, expanding access for families needing support.
How to Apply for MLTSS and Access Mental Health Services?
The application process for MLTSS varies depending on age:
For Individuals 21 and Older:
- Contact your local County Area Agency on Aging (AAA) – Aging and Disability Resource Connection (ADRC). They can provide detailed information about services and resources in your area and conduct clinical screenings for MLTSS eligibility.
For Children Birth Through 20 Years Old:
- Contact the Division of Disabilities Services (DDS) at 1-888-285-3036 (press 2, then press 1). An Information and Referral Specialist can guide you through the process.
Program of All-Inclusive Care for the Elderly (PACE):
- Another option to consider is the PACE program, available in certain service areas within ten counties. Click here for more information about PACE.
For any further inquiries about MLTSS, you can Click Here to E-mail Questions about MLTSS.
In conclusion, Managed Long Term Services and Supports (MLTSS) in New Jersey offers a vital pathway to accessing comprehensive long-term care, crucially including mental health and addiction services. By understanding the program’s scope, eligibility criteria, and application process, individuals and families can take informed steps to secure the support they need to enhance well-being and quality of life. Contacting the appropriate agencies based on age is the recommended first step to explore MLTSS benefits further.
