Medicaid Eligibility and DDD
Effective January 22, 2013, the Division of Developmental Disabilities (Division) eligibility regulations changed. Medicaid eligibility is now required in order to receive Division-funded services. This important reform ensures the state's ability to maximize the receipt of federal revenue, and to preserve and enhance community-based supports for individuals with intellectual and developmental disabilities.
What if I am not eligible for Supplemental Security Income?
As a result of this change:
• Individuals new to the Division are required to meet the 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 must become Medicaid eligible to ensure continuation of current services and prior to receiving any new service. The Division is identifying individuals who are receiving services and are not Medicaid eligible and working with them to obtain Medicaid eligibility.
Because there are different ways to initiate the Medicaid eligibility process, it is important to review the following information.
Supplemental Security Income (SSI) is highly recommended for individuals with intellectual or developmental disabilities who turn 18 years of age and expect to pursue Division-funded services.
• The Supplemental Security Income (SSI) program pays benefits to adults with disabilities (after their 18th birthday) who have limited income and resources.
• For adults 18 years of age and older, the federal Social Security Administration (SSA) no longer counts parental income and resources for eligibility for SSI.
• Every New Jersey resident who receives Supplemental Security Income will automatically receive New Jersey Medicaid. Having SSI protects Medicaid eligibility for the future.
For additional information, please see the Supplemental Security Income (SSI) Fact Sheet.
The monthly income and resource limits for Supplemental Security Income (SSI) eligibility are different than the limits for New Jersey Medicaid eligibility (please see the Division's 2015 Medicaid Eligibility for the Supports Program Fact Sheet).
Therefore, if you have a monthly income and/or financial resources that are above the Supplemental Security Income (SSI) limits, you can still apply for New Jersey Medicaid by following these steps:
(1) Visit your County Board of Social Services (welfare agency) to apply for Medicaid (New Jersey Care or Workability).
(2) Be sure you bring the required documents when applying, by reviewing the Medicaid Document Verification Checklist before you go.
(3) To ensure continuation of any current Division-funded services, please be sure to keep the Division informed of the progress of your Medicaid application by sending updates to the Division's Medicaid Eligibility Helpdesk at DDD.MediEligHelpdesk@dhs.state.nj.us
What is DAC (Disabled Adult Child) vs. Non-DAC Status?
DAC: What Does it Mean?
The 1634 DAC (Disabled Adult Child) designation comes from the federal Social Security Administration. If an individual meets all of the criteria below, they may qualify for Medicaid as a Disabled Adult Child under Section 1634 of the Social Security Act (regarding DAC). Eligibility for Medicaid may 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, they may become ineligible for Medicaid coverage.
An individual may be eligible as a 1634 DAC if he or she:
• 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 Supplemental Security Income (SSI) due to the receipt of Social Security benefits on a parent’s record due to the retirement, death or disability of a parent.
For additional information, please review Disabled Adult Children (1634 DAC).
Non-DAC: What Does it Mean?
A limited group of individuals has been identified who have never received an SSI benefit prior to receiving their current SSDI benefit due to a parent’s retirement or survivor benefit, and are therefore not eligible as a §1634 DAC. 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” (as long as the individual does not have other income or assets that would otherwise create a barrier to Medicaid eligibility). This designation does not impact the Medicaid eligibility determination but is an internal Division designation.
Until further notice, any individual determined as a “Non-DAC” through review by the Medicaid Eligibility Helpdesk will continue to receive current Division-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.
In addition, individuals completing the Division’s intake process designated as “Non-DAC” will be able to receive day and other support services.
What do I do if Medicaid eligibility is denied or terminated?
If you are receiving or wish to receive Division-funded services and Medicaid eligibility is denied or terminated, please take the following steps to notify the Division's Medicaid Eligibility Helpdesk:
(1) Complete the Division's Medicaid Eligibility Troubleshooting Form
(2) Submit the Medicaid Eligibility Troubleshooting Form, along with a copy of the denial/termination letter you received from Medicaid, to the Medicaid Eligibility Helpdesk.
How is the Division assisting individuals who are already receiving Division-funded services to become Medicaid eligible?
Ensuring that individuals who had been receiving services in the non-Medicaid service system obtain Medicaid eligibility has required significant effort and collaboration between individuals, families, providers and the state.
The Division has developed a statewide database to track the progress of individuals who are working to become Medicaid eligible, and to monitor other Medicaid-related issues.
How can I access my Supplemental Security Income information?
If you are already receiving monthly SSI or SSDI benefits, you may create an online My Social Security account to access your benefit information, change your address and direct deposit, and print your own Social Security and/or Supplemental Security Income Benefit Award Letters.
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.
Individuals age 18 and older can create a secure My Social Security account at: www.socialsecurity.gov/myaccount
How to Create an Online Account
What You Can Do Online
How can I report a change in my income/wages to the Social Security Administration?
Supplemental Security Income (SSI) is a needs-based program for people who are disabled, blind or aged. In other words, the amount an eligible person can receive is based on his or her income. Therefore, it is very important that up-to-date wage information is reported to the Social Security Administration.
SSI Telephone Wage Reporting
Wage Reporting Participant Training Package FY 2013
Disabled Adult Children (1634 DAC)
How to Apply Online for Social Security Disability Benefits
Medicaid Document Verification Checklist
Medicaid Eligibility for the Supports Program
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI): Understanding the Difference
Supplemental Security Income (SSI) and Continued Medicaid Eligibility (1619b)
Contact the Division's Medicaid Eligibility Help Desk
New Jersey Department of Human Services
Division of Developmental Disabilities
1B Laurel Dr.
Flanders, NJ 07836
Attention: Medicaid Eligibility Project