Funding Sources for Adult Services

Click below for a listing of eligibility requirements and services offered by the following programs: 
Medicaid
Supplemental Security Income
Social Security Disability Insurance
Checklist 


Medicaid

Medicaid is a federal funding system which is administered in New Jersey by the Division of Medical Assistance & Health Services (DMAHS). Medicaid pays for a wide array of services for people with disabilities and their families and provides government-funded health insurance, including prescription coverage and personal care services, for children and adults with disabilities who have limited financial resources. Medicaid also provides government funding for long-term services and supports, including institutional care, and, increasingly, community based services such as group homes and self-directed services. These community-based services are funded through a "waiver" known as the Community Care Waiver (CCW).

In New Jersey, the CCW is the primary funding source for adult services through DDD. The CCW allows the state to use federal and state funding for flexible services that are more person-centered. The CCW is for individuals with developmental disabilities who would otherwise require an institutional level of care, but who can be served at home. The CCW funds case management, respite care, habilitation (including pre-vocational, educational, and supported employment services), home and vehicle accessibility adaptations, personal emergency response systems, therapies, and other individual supports.  To learn more, visit DDD's website.

Even if a person has private health insurance, Medicaid may pay for services that most private insurance plans do not cover such as private duty nursing, medical supplies, or even residential placement. In order to maximize federal funding, DDD requires all participants to maintain Medicaid eligibility.

Exclamation PointEffective January 22, 2013:  The Division of Developmental Disabilities (DDD) has issued a new rule requiring all individuals 21 and older, who are eligible to receive DDD services, to now also be Medicaid eligible by March 23, 2013 or the individual is in danger of losing services.  Read more>>

What You Can Do:

  • Autism NJ recommends that families establish a special needs trust in order to protect assets and ensure continued eligibility for important Medicaid benefits.
  • Talk to family members and loved ones who may be planning to leave money to your child with autism. Advise them on the need to put any gifts for your child into a special needs trust. 

Eligibility

Eligibility for Medicaid is based on assessment of both disability and financial resources. Most adults who are DDD-eligible will meet the Medicaid definition of disability. Medicaid has stringent asset and earnings guidelines. Generally, Medicaid eligibility depends upon a person's satisfying the requirements for the federal Supplemental Security Income (SSI) program. Medicaid “waivers” permitting higher monthly earnings may apply in some circumstances. With the exception of these waiver programs, the income and resources of parents of children under age 18 are considered.

Service Rights

Once eligible for Medicaid, a person must receive services and cannot be placed on a waiting list. Under Medicaid regulations, a state cannot limit access to covered medical services simply because the cost of service exceeds the state budget. In New Jersey, certain "waiver" programs limit the number of participants.

What You Can Do:

  • Parents and other family members should not place assets in excess of $2,000 in the name of the person with autism.
  • If the person with autism has assets in his or her name in excess of $2,000, and the value is modest, spend them or reimburse the family for expenses already incurred. 
  • Inheritance and lifetime gifts should be made to a special needs trust and not the individual with autism. 

Waiting Lists

Once eligible for Medicaid services, no waiting lists for services are allowed.

Financial Contributions for Services

If an individual acquires assets or resources, such as in the case of inheritance or earnings, they may become ineligible and be required to reimburse Medicaid. 

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Supplemental Security Income

The SSI program makes cash assistance payments to aged, blind and disabled people (including children under age 18) who have limited income and resources. 

No work history is required to receive SSI benefits. There is also no waiting period. An individual may receive benefits as of the first day of the month following the month of application. The SSI benefit usually ranges between $400 and $600 per month. A person who qualifies for SSI also will qualify for Medicaid.

Eligibility

In most cases, to qualify for SSI a person with a disability can have no more than approximately $700 to $800 in monthly income and no more than $2,000 in countable resources. Countable resources are the person’s property (other than certain exempt resources, such as the house one lives in and one car). The person also must have a disability that prevents gainful employment. When the person is under age 18 and living at home, family income and resources will be counted. However, once the applicant turns 18, family resources will not be counted even if the applicant continues living at home. What then matters is only the income and resources of the person. For this reason, most people with disabilities qualify for the first time at age 18.

You should know...

  • Many parents and well-intentioned relatives will open a bank account or purchase savings bonds in the name of a minor with a disability, only to realize at age 18 that their child is not eligible because savings are in excess of $2,000. As harsh as this may sound, a child with a significant disability should not have assets put in his or her name. A special needs trust should be considered. 
  • A bank account or other assets held in the name of the person with autism, which causes SSI disqualification also will cause Medicaid disqualification. There are several additional ways to qualify for Medicaid, even if the applicant cannot meet the SSI income and resource tests. For example, an applicant who loses SSI simply because he or she is collecting regular Social Security (SSA) as a dependent of a parent who dies or retires will continue to receive Medicaid benefits. Also, applicants whose income places them slightly over the Medicaid limit may still be eligible under alternative eligibility criteria. There are waivers and work incentive programs that allow an individual to remain on SSI and Medicaid and still have earnings in excess of the minimum monthly allowable requirements. Families should inquire directly with SSI and Medicaid about these programs. For information on Social Security Work Incentive Programs, contact NJWINS

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Social Security Disability Insurance (SSDI)

SSDI provides benefits to aged, disabled or blind individuals who are "insured" by workers’ contributions to the Social Security trust fund. These contributions are the Federal Insurance Contributions Act (FICA) Social Security tax paid on their earnings or those of their spouses or parents. As with SSI above, individuals can have no more than approximately $700 to $800 in monthly income and no more than $2,000 in countable resources. If an individual is eligible for SSDI benefits, they will also receive Medicare coverage; however, the first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. 

Eligibility

Individuals who are aged, blind or disabled who have worked and paid Social Security taxes for enough years to be covered under Social Security insurance are eligible to receive SSDI. Some of the taxes must have been paid in recent years and the individual must be the worker, the worker's widow(er) or the worker's disabled adult child. The disabled child must be unmarried, age 18 or over, and his/her disability must have begun before the age of 22. 

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Checklist:

  • Have you applied for social security benefits such as: 
    • Social Security Disability Income (SSDI)?
    • Supplemental Security Income (SSI)?
  • Have you applied for Medicaid Services

For more information, please visit the Social Security website.

Exclamation PointVisit our Government Agencies page for contact information for Medicaid and Social Security.  

 

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AUTISM NEW JERSEY
500 Horizon Drive, Suite 530 Robbinsville, NJ 08691
Phone: 609.588.8200; 800.4.AUTISM | Fax: 609.588.8858
Email: information@autismnj.org

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