Are You Eligible for Medicaid?

January 05, 2018

Medicaid is required in order to receive DDD Services. The most frequent path to Medicaid is Social Security. However, even if you aren’t eligible for Social Security (usually because your income is too high), you might still be eligible for Medicaid. This article provides information on the different ways to qualify for Medicaid.

Do you qualify for SSI?

Do you qualify for SSI?

Supplemental Security Income (SSI)

Most frequently, an individual with autism will qualify for Medicaid due to Supplemental Security Income (SSI) eligibility. This is because New Jersey residents who qualify for SSI are automatically eligible for Medicaid. SSI is a Federal income supplement program that is designed to help aged, blind, and disabled people who have little or no income. It provides cash to meet basic needs for food, clothing, and shelter. People who meet the eligibility requirements for DDD services typically meet the SSI disability definition as well.

Before age 18, many individuals with autism will be ineligible for Medicaid through SSI because their family’s income is counted as a resource, and it is too high. However, after age 18, even if the person still resides with family, only their own financial resources are considered. This allows many individuals to become eligible.

No SSI due to SSDI

Did you lose SSI eligibility due to SSDI?

Disabled Adult Children

A Disabled Adult Child (DAC) is someone who is at least 18 years of age; has blindness or a disability which began before the age of 22; has been receiving Supplemental Security Income (SSI) based on blindness or disability; and has lost SSI due to the receipt of Social Security Disability Insurance (SSDI) benefits on a parent’s record due to the retirement, death or disability of a parent.

If the person meets all of the above criteria, s/he may qualify for Medicaid as Disabled Adult Child (DAC). This designation comes from the Social Security Administration. It allows the County Welfare Agency not to count this benefit against their Medicaid eligibility. Medicaid will continue as long as the person is determined blind or disabled. However, if the person receives income from another source or exceeds the resource limits, s/he may become ineligible for Medicaid coverage. This fact sheet from DDD explains how DACs can obtain Medicaid.

Individuals Designated as “Non-DACs”

There are some individuals who currently receive SSDI benefits through a parent’s record who have never received SSI in the past, and are not eligible as DACs. Because their SSDI benefit qualifies as income, they have been deemed ineligible for Medicaid. The Division designates this group of individuals as “Non-DAC” (as long as the individual does not have other income or assets that would otherwise create a barrier to Medicaid eligibility).

Until DDD creates a pathway for “Non-DACs” to obtain Medicaid eligibility, individuals will continue to receive current Division-funded services. In addition, individuals completing the Division’s intake process designated as “Non-DAC” will be able to receive day and other support services.

Not SSI Eligible

If you are not SSI Eligible

New Jersey WorkAbility

People with disabilities who work may qualify for a special Medicaid program called the NJ WorkAbility Program, which offers full New Jersey Medicaid health coverage to people whose earnings would otherwise make them ineligible to qualify for Medicaid. As of 2016, individuals can have an earned income of up to $60,625.

Community Medicaid for Low-Income Individuals

Individuals with low income who do not receive Medicaid through SSI can qualify for Community Medicaid. Single adults with a modified adjusted gross income up to 138% of the Federal Poverty Level ($1367 per month effective 2016) are financially eligible. The NJ FamilyCare website provides additional information and an application.