Medicaid Eligibility and DDD
Please review the information below regarding medicaid eligibility. Once finished, should you still feel that you need assistance with applying for Medicaid then please fill out this Medicaid Eligibility Troubleshooting Form and send it to DDD.MediElighelpdesk@dhs.state.nj.us.
UpdatesNew Update - December 16, 2013 - "Non-DAC" Designation
The Division continues to collect and review unique cases in which Medicaid Eligibility may be problematic. As such, we have identified a limited group of individuals who have never received an SSI benefit prior to receiving their current SSDI, due to a parent’s retirement or survivor benefit. As a result of this benefit, which qualifies as income, they have been deemed ineligible for Medicaid. The Division designates this group of individuals as “Non-DAC”.
Until further notice, any individual determined as a “Non-DAC” through review by the Medicaid Helpdesk will continue to receive their current state-funded services while we work with Medicaid to identify eligibility solutions. Continuation of these services will be contingent on the final outcome of these policy decisions.
All individuals in this category are being notified via letter. Click to view letter. If you have any questions please contact your Division Case Manager.
July 1, 2013
The Division’s Medicaid Eligibility Project (MEP) continues to need status updates for individuals who are currently receiving a service from the Division but are not currently Medicaid eligible. As individuals are identified who have been denied Medicaid eligibility, but who are still requesting services, a detailed Troubleshooting Form must be submitted along with the Medicaid denial letter to the Medicaid Eligibility Helpdesk at: DDD.MediEligHelpdesk@dhs.state.nj.us. (The Troubleshooting form should not be used to provide general updates.) We also require status updates for individuals who are not currently Medicaid eligible but are in the application process.
If an individual is identified who is not currently Medicaid eligible but the services needed appear emergent and are based on life safety issues, the Division Case Manager will present the case to their Supervisors and Regional Administrator for review.
As we move forward, Division staff will be provided a list of individuals who have been identified by the MEP and approved to receive a time limited Division service as detailed below. These individuals are either pending Medicaid determination or fall into a specific category of individuals who cannot become Medicaid eligible because of an issue related to receiving their parents’ retirement or death benefit prior to them applying for SSI (this group is the “Non-DAC” group.) These services can continue as follows (and the list will reflect these dates):
Ongoing Family Support Services and SDDS Renewals
- Pending Medicaid Determination - Current ongoing services and plans can be renewed for these individuals through September 30, 2013 pending the final Medicaid determination.
- Non-DAC - Service planning can begin for these individuals with services approved through December 31, 2013.
- Pending Medicaid Determination - Staff can begin, or continue, service planning for these individuals but the service cannot be approved beyond September 30, 2013 pending the final Medicaid determination.
New Requests for Services
Individuals requesting a new service who are not yet Medicaid eligible will have their request put on hold pending their Medicaid eligibility determination. If an individual has been denied Medicaid, the request will be put on hold and a Troubleshooting form, with the Medicaid denial letter, will be required for review. The outcome of the troubleshooting review and possible service provision will be communicated to the family by the Division.
What is the new requirement for Medicaid eligibility related to DDD?Effective January 22, 2013, the Division of Developmental Disabilities (Division) eligibility regulations changed to require Medicaid eligibility as a condition of receiving Division-funded services. This important reform is necessary to ensure that the State can maximize the receipt of federal revenue and preserve and enhance community-based supports for individuals with developmental disabilities system-wide. As a result of this change:
- Individuals new to the Division are required to meet both functional criteria and have Medicaid eligibility before they can begin receiving a service.
- Individuals already receiving Division-funded services who are not already Medicaid eligible will have to become Medicaid eligible before receiving any new service and to ensure continuation of current services.
- In some cases, the Division has extended the original 60 day requirement, when the individual is working to obtain Medicaid eligibility but experiencing delays from DDD or the State or County Medicaid offices.
- The Division is actively working to identify individuals who are receiving services but are not currently Medicaid eligible and work with them to obtain Medicaid eligibility. There are different ways to initiate the Medicaid eligibility process, depending on the type of services being received, as well as other factors. Please review the Applying for Medicaid section below for additional information about the different ways to become Medicaid eligible, depending on an individual's needs and current services.
What is the Division doing to assist individuals who are already receiving services to become Medicaid eligible so that they do not risk losing their services?This initial “clean-up” to get everyone in the current service system eligible for Medicaid is going to require significant efforts and a collaborative process between individuals, families, providers and the State.
The Division has developed - and will be continually updating – a “Medicaid Eligibility and DDD” section on the website where fact sheets and other useful resources related to this issue will be shared with stakeholders. The Division has also established a dedicated phone line (609-631-6505) and email Help Desk account (DDD.MediElighelpdesk@dhs.state.nj.us) to receive communications with individuals, families, and providers related to issues with Medicaid eligibility.
The Division is developing a statewide database of individuals currently receiving services who are not Medicaid eligible, so we can track individual’s progress toward becoming Medicaid eligible, as well as any issues as they arise.
The Division has begun sending letters to individuals who may be impacted by this regulatory change, along with informational materials to assist them in initiating the process. Individuals who are in residential services and in day programs are the first groups who will be getting letters. Copies of these letters will also be available to providers, along with a list of anyone the Division has identified as receiving residential or day program services from the provider who is not currently Medicaid eligible. This will enable the providers to assist individuals and their families in navigating the Medicaid eligibility process as well.
What are the different avenues an individual can use to become Medicaid eligible and how should an individual know which avenue they should use? There are different ways to initiate the Medicaid eligibility process, depending on the type of services you are receiving, as well as other factors.
This is the process is for individuals applying for Medicaid who are expected to be enrolled on the Community Care Waiver:
- Contact their DDD case manager to ensure that their file has: (1) an updated Self-Care Assessment Tool (SCAT), (2) an ICF/MR Certification/Level of Care Form, (3) Freedom of Choice form, and (4) Admission to Waiver Services form.
- Once those forms are updated, the Medicaid Only Application needs to be filled out and a physician will need to complete the supporting medical form.
- Once that Application and medical form is filled out, they should be mailed, along with all supporting documentation, to: Division of Developmental Disabilities, Central Office, P.O. Box 726, Trenton, NJ 08625-0726, Attention: Medicaid Eligibility Project.
This is the process is for individuals applying for Medicaid who are expected to eventually be enrolled on the Supports Program:
- Contact their County Welfare Agency (CWA)/Board of Social Services (BSS) to schedule an appointment to apply for Medicaid.
- On the day of the appointment, bring the required documents listed on the document: DDD Medicaid Eligibility for the Supports Program and Applying for Medicaid.
- In order to ensure continuation of your services while you are completing the Medicaid eligibility process, it is essential that the Division has a record of your progress. Please contact us via email at DDD.MediElighelpdesk@dhs.state.nj.us no later than March 1, 2013 to let us know where you are in the eligibility process (i.e. whether you have a scheduled appointment with your CWA/BSDS, the date, etc).
If you have already applied and been determined ineligible for Medicaid within the last six months, please send a copy of your ineligibility determination letter to the Division’s Central Office, at: Division of Developmental Disabilities, Central Office, P.O. Box 726, Trenton, NJ 08625-0726, Attention: Medicaid Eligibility Project.
Applying for Medicaid2/07/13 - Medicaid Eligibility Letter for Consumers
Under the Community Care Waiver (CCW)[green]: If you expect to be enrolled for services through the CCW then please review the DDD Medicaid Eligibility for the Community Care Waiver (CCW) fact sheet and refer to the Community Care Waiver checklist to verify that you will have the correct information for your appointment.
Under the Supports Program (SP)[blue]: If you expect to be enrolled for services through the SP then please review the DDD Medicaid Eligibility for the Supports Program (SP) fact sheet and refer to the New Jersey Care....Special Medicaid Programs checklist to verify that you will have the correct information for your appointment.
Medicaid Eligibility Letters to Provider AgenciesFor Agencies Providing Residential Services
For Agencies Providing Day Program Services
Fact Sheets and Frequently Asked Questions
Medicaid And DDD FAQ
Social Security InformationThe Difference Between SSDI and SSI
How to Apply Online for Social Security Disability Benefits
Designation as Disabled Adult Children
Spotlight on Continued Medicaid Eligibility for People Who Work
Information About SSA Award Letter for New Jersey Residents
“My Social Security account”
My Social Security is a very important service offering that affects workers of every age since many currently are working or already are receiving Social Security (and/or Supplemental Security Income) benefits.
For those already receiving (SSI or SSDI monthly benefits), you may access your benefit information online and change your address and direct deposit, all without calling or visiting a Social Security office. (This is especially important for individuals who must provide proof of your income when applying for Medicaid, Housing, nutrition (SNAP) or energy (LI HEAP) assistance programs because you’re able to print your own Social Security and/or Supplemental Security Income Benefit Award Letters which means no more waiting for the mail!)
People age 18 and older can sign up for an account at www.socialsecurity.gov/myaccount. Once there, they must be able to provide information about themselves and answers to questions that only they are likely to know. After completing the secure verification process, people can create a My Social Security account with a unique user name and password to access their information.
How to Create an Online Account
What You Can Do Online
SSI MONTHLY WAGE REPORTING
Supplemental Security Income (SSI) is a needs-based program for people who are disabled, blind or aged. The amount an eligible person can receive is based on his or her income. You can help us make timely and accurate payments to people who get SSI and work by participating in our monthly wage reporting.
Wages continue to be a major source of payment error in the SSI program. Primarily, these deficiencies are related to obtaining accurate monthly wage information on a timely basis. Social Security Administration is committed to simplify and streamline the monthly wage reporting process in an effort to ensure the beneficiary receives the correct benefit amount each month and to avoid unnecessary underpayments and overpayments.
The attached information provides you and your clients with the resources to accurately and timely report your monthly gross wages to the Social Security Administration.
SSI Telephone Wage Reporting
Wage Reporting Participant Training Package FY 2013
Contact UsDivision of Developmental Disabilities
P.O. Box 726,
Trenton, NJ 08625-0726
Attention: Medicaid Eligibility Project