Understanding the Adult Service System
We recognize that the adult service system is complicated. Understanding the system and funding can be difficult, even for the most seasoned advocates. There are many rules and steps to follow. In this section, we will be providing information, articles, FAQs and updates to help you better understand the system.
After educational entitlement ends at age 21, individuals will rely on other resources to help meet their needs in a variety of areas such as housing, employment, habilitation, recreation, behavior, transportation and more. In order to receive state-funded services, individuals must first become eligible for those services (by applying and meeting a set of criteria). Unlike education, the service systems for adults are not an entitlement (services are not guaranteed by law to be available).
Adult services are based not only on eligibility and assessed level of need, but also on the availability of funding. When funding is not available, individuals may experience significant wait times.
The primary funding source for services for individuals with autism runs through the New Jersey Division of Developmental Disabilities (DDD).
Aged 18 to 21? DDD can establish eligibility for individuals beginning at age 18 and services are available beginning at age 21. For individuals applying for services between the ages of 18 and 21, the New Jersey Department of Children and Families Division of Children’s System of Care (CSOC) accepts DDD eligibility determinations and provides services until age 21.
The Path to Services
We’ve outlined the four general steps along the path to receiving services from DDD. Click on the links below to learn more.
Are you eligible?
Applying for Division of Developmental Disabilities (DDD) Services
In order to be eligible for DDD services, individuals must first apply and meet the eligibility criteria. The criteria, as well as an application, are on the DDD website.
Essentially, an individual must be:
- Diagnosed with a developmental disability;
- Eligible for Medicaid; and
- A legal resident of New Jersey.
An in-depth description of the criteria and the process of determining eligibility is provided in Division Circular #3.
How to Apply:
Complete DDD’s Intake Application Package and return to a the DDD Community Services Office in the county in which you live. Learn more>>
Medicaid: Why Eligibility is Essential
In order to access DDD services, all new and existing clients must meet the eligibility requirements for DDD and obtain and maintain eligibility for Medicaid. This is because DDD has transitioned to a Medicaid-based Fee-for-Service (FFS) system of reimbursement. Anyone who is new to DDD will be enrolled into one of two programs under the FFS system: the Supports Program (SP) or the Community Care Program (CCP). Existing DDD clients and their service providers are gradually being transitioned from a contract-based system.
Identifying your needs.
Assessment, Tiers, and Budgets
In the Fee-for Service Medicaid payment system, providers are reimbursed for individual services. The amount of money available to pay for services is the individual’s budget. Budgets are determined based on the results of the NJ Comprehensive Assessment Tool (NJ CAT), which must be completed by the individual, family member, provider or other individual who is familiar with the person needing services.
Once complete, the assessment is then scored and the individual is assigned a budget tier. The budget enables individuals to pay for services up to a certain dollar amount for employment/day supports and individual/family supports. Individuals enrolled in the Community Care Program (CCP) also have a budget for individual supports either in their own home or in another residential setting. See DDD’s reference guide with charts showing the budget amounts for services according to one’s tier assignment in the Supports Program or CCP.
The New Jersey Comprehensive Assessment Tool (NJ CAT)
The NJ CAT is the mandatory needs-based assessment used by DDD as part of the process of determining an individual’s eligibility, and assigning their budget tier. The NJ CAT must be completed by or for all current DDD clients and anyone new to DDD. Contact the Intake/Intensive Unit of your DDD Community Services Office to request access to complete the NJ CAT through a password-protected online survey or over the telephone. Additionally, DDD’s NJ CAT Resource Page provides an overview and information on how to access the assessment.
Tips on Completing the NJ CAT
The CAT must be completed by the individual, family member, provider, or other individual who is familiar with the person needing services. Sometimes, it can be challenging for parents and caregivers to step back and evaluate the true extent of a person’s dependence and self-care needs. They may become accustomed to providing a certain level of assistance and support to the individual. To ensure that responses to the NJ CAT will result in a budget that would accurately reflects the person’s need for services if they did not have support from their regular caregiver, review these tips.
Make a plan.
The Planning Process
The planning process helps determine what services are needed and desired by the individual. If you don’t already have one, you’ll need to identify and engage a Support Coordination Agency to execute the planning process. The planning process is team-based, requiring the input of the individual, their guardian (if applicable) and the Support Coordinator.
Support Coordination (SC) is a Division-funded service assists individuals in gaining access to needed program and State plan services, as well as needed medical, social, educational and other services. Support Coordination is a component of the new Medicaid-based, fee-for-service system. All individuals who are eligible for and wish to access Division-funded services must either select or be assigned to a Support Coordination Agency (SCA).
The Support Coordination Agency assigns a Support Coordinator to work with the individual and his/her family to ensure completion of the Person-Centered Planning Tool (PCPT) and to develop and maintain the Individualized Service Plan (ISP). After the ISP is created, the Support Coordinator helps to link the participant to programs and services that match their needs and desired outcomes and ensure that services and supports remain within the allotted budget.
Once fee-for-service is fully implemented, all clients, including those on the Community Care Waiver, will access services through their Support Coordinator.
Need help finding one?
Autism New Jersey’s online referral database includes a list of agencies that are DDD/Medicaid–approved to provide support coordination. Support Coordination Agencies are categorized under Adult Services, and the list of agencies can be narrowed down by the counties they serve.
Connect to services.
Once the assessment and planning process is complete, individuals can access necessary services from a variety of Medicaid-approved providers. The path to services does not end here; it is ongoing. Services change as needs change.
DDD’s website provides a full list of services available through the waiver.
Remember, the types of services you are able to access will depend on if you are enrolled in the Supports Program or the CCP.