Global Options for Long Term Care in New Jersey

By Fredrick P. Niemann, Esq. of Hanlon Niemann, a Monmouth County, New Jersey Medicaid Eligibility Attorney

The Global Options program (GO) is a great alternative to a nursing home.  The New Jersey Department of Services, Division of Aging operates the Medicaid Waiver program specifically for older adults age 65+, or persons with physical disabilities between the ages 21-64, who are medically capable of receiving home and community-based services instead of living in a nursing home.

GO participants are assigned to and thereafter work with a Care Manager to create an individualized and personalized Plan of Care based on their assessed care needs.  GO participants even have the option to hire and direct their own service providers.  I’ll discuss this further later on.  Once the Plan of Care is approved, the Care Manager will arrange service providers and contact the participants monthly to ensure that their services continue to meet their care needs.

Global Options is NOT intended to replace an applicant’s family community support network.  Instead, it offers support to fill the gaps that cannot be met by family and friends.  GO strengthens the ability of caregivers to continue in their critical role as the main support providers.

There are limits to what is available and permitted.  Service agencies must be approved by Medicaid and some support services may not be available in your county.  The State sets the rates that agencies are paid and the individual cost cap that participants cannot exceed, and prior authorization for certain services may be required.  Payments are made on a fee-for-service basis and paid directly to service agencies.  Money is NOT distributed to participants or caregivers under any circumstances.  It is also important to understand that in all cases, Medicaid is considered the payer of last resort.

WHAT ARE THE CRITERIA TO RECEIVE ELIGIBILITY FOR GO

In order to be eligible for Global Options, an applicant must meet all of the following criteria:

  • Be a resident of New Jersey
  • Be 65 years old or older, or is between the ages of 21-65 and determined physically disabled by the Social Security Administration or by the Disability Review Section of the Division of Medical Assistance and Health Services.
  • Qualify for Medicaid financial eligibility by:
    • Qualifying for SSI in the community, or
    • Qualifying for Medicaid Only – Institutional Level, or
    • Qualifying for New Jersey Care (with income at or below 100% of the federal Poverty Level and resources at or below $4,000).
    • Meet Clinical eligibility, which is determined by a State or county professional as needing Nursing Facility Level of Care.
    • Reside in an approved community living arrangement.
    • Want to enroll and receive Waiver services rather than live in a nursing home.

When Is An Individual Not Eligible for GO Under Current Regulations

  • Individuals between the ages of 21 and 64 who are chronically mentally ill, intellectually disabled or developmentally disabled are ineligible for Global Options for Long-Term Care enrollment.

Once enrolled, participants may remain on Global Options as long as they choose, provided they remain eligible and abide by program rules.

At any time, if a GO participant no longer meets these eligibility and enrollment criteria, he or she may be terminated from the program due to ineligibility.

SERVICES

What Services are Provided By the State Under the Global Options Program?

The following services may be available if approved and included as your personalized care plan.  These services are taken directly from the state’s website and policy manual.

  • Assisted Living/Adult Family Care Assistance
  • Personal Attendant Care
  • Caregiver Participant Training
  • Care Management
  • Chore Services
  • Community Transition Services
  • Environmental Accessibility Adaptations
  • Home-Based Supportive Care (HBSC)
  • Home Delivered Meal Services
  • Personal Emergency Response Systems
  • Respite
  • Special Medical Equipment and Supplies
  • Social Adult Day Care
  • Transitional Care Management
  • Transportation

 

GO participants can also be eligible for additional services under the Medicaid State Plan including:

  • Adult Day Health
  • Advanced Practice Nurse
  • Chiropractic
  • Clinic
  • Dental
  • Hearing Aid
  • Home Health
  • Hospital
  • Hospital Outpatient
  • Laboratory
  • Medical Supplies Equipment
  • Nursing facility
  • Optometric
  • Optical Appliances
  • Personal Care Assistant (PCA)
  • Pharmaceutical
  • Physician
  • Podiatric
  • Prosthetic and Orthotic Devices
  • Rehabilitation Therapies
  • Transportation

 

There Are Limitations to the Services Available

The services of a Personal Care Assistant (PCA) and Home Based Supportive Care (HBSC) are mutually exclusive of one another.  That means that a participant must choose either a PCA or HBSC, but cannot receive both.

All GO services are subject to limitations.  These limitations are described generally as follows:

  • Services are to be cost-effective, while supporting a person’s care needs.
  • Services are designed to supplement, not replace, the assistance already being provided by family, friends and neighbors.
  • Services are for the GO participant, NOT other household members.
  • Services are designed according to the Plan of Care.
  • GO cannot be used to pay for what currently is being paid privately or through another program.
  • GO Waiver services are not available while an individual is an inpatient of a hospital or nursing home for an acute medical stay.

 

Who Is Eligible to Provide These Services to Qualified Persons?

Services can be provided to qualified persons, County and/or local Medicaid community agencies, qualified third parties and even family members but all service providers must meet qualification requirements determined by the State of New Jersey.

 

What Does a Care Manager Do, If I Qualify For One?

A Care Manager is a person who is experienced in working with older adults and adults with physical disabilities.  Every Global Options participant must receive Care Management as a Waiver service.

Care Managers will help GO participants by:

  • Continually reassessing their care needs for Waiver services;
  • Developing and reviewing the Plan of Care;
  • Authorizing Services;
  • Coordinating services and providers;
  • Making sure that services are delivered according to the Plan of Care;
  • Monitoring participants’ general health and welfare through regular contacts and home visits;
  • Monitoring the participant’s individual cost cap; and
  • Determining the cost share of Assisted Living/Adult Family Care participants.

These services are mandatory according to the state’s published materials.


What is a Plan of Care And What Does It Mean to Me?

The Plan of Care is a plan created for the individual based on his/her assessed care needs.  It outlines what services and supports are necessary to achieve your reasonable health care requirements.  Each Plan of Care is individualized for every GO participant.  The Plan of Care is reviewed continually, and updated at least annually, to ensure that each participant is getting the appropriate services that he or she needs.

 

What Does Participant-Directed Care Mean?

Global Options was designed to provide independence to participants so they have more control over managing their care.

If medically capable, a participant can choose to direct their own care, including managing their own state-authorized budget and/or hiring their own state-approved employee, possibly even friends or family.

Participant-Directed Care also means that a participant, with the help of your Care Manager, will:

  • Determine what services you need;
  • Select who will provide them;
  • Determine when and how they should be delivered; and
  • Make sure services are provided as listed in the Plan of Care.

 

Is There a Cost for GO Services?

There is no cost to the participant for GO services except for the Assisted Living or Adult Family Care services.  For those services, a person is always responsible to pay Room and Board fees.  GO participants who live in an Assisted Living facility or Adult Family Care home are expected to contribute to the cost of their services.  This is called a “Cost Share”.  The amount of your Cost Share depends on a participant’s income.

Cost Share liability is determined after a participant is approved for GO.

Determining the Cost Share amount involves these steps:

  1. Listing your income from all sources;
  2. Subtracting Allowable Deductions such as the cost permitted to cover medical insurance premiums;
  3. Using the remainder to determine how much you will pay as your Cost Share.

If you have questions regarding Medicaid eligibility for the Global Options Program, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.