Medicaid for Adults

January 05, 2018

This article is a part of our
Health Insurance and Autism Series.

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Adults must have Medicaid 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)

You may be able to get Medicaid by applying for  Supplemental Security Income (SSI) eligibility. 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 they reach age 18, many individuals with autism would have been 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 for SSI and, through that, for Medicaid.

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 old; has blindness or a disability that 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 their parent’s retirement, death or disability.

If you meet all of the above criteria, you may still qualify for Medicaid as Disabled Adult Child (DAC). This designation comes from the Social Security Administration. It prevents the County Welfare Agency from counting an SSDI benefit against an individual’s Medicaid eligibility. Medicaid will continue as long as the person is determined blind or disabled. However, if that person receives income from another source or exceeds the resource limits, they 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 for Medicaid because their SSDI benefit qualifies as income. DDD 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) and provides services to non-DAC individuals despite their Medicaid ineligibility.

Until DDD creates a pathway for “non-DACs” to obtain Medicaid eligibility, this arrangement is unlikely to change and DDD will continue to offer services to non-DAC individuals who have no Medicaid coverage.

If you believe you fall into the non-DAC category, and want to apply to DDD, you must go through DDD’s intake process designated as “Non-DAC.” You will then 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 2022, individuals can have an earned income of up to $68,748 and still qualify for Medicaid under this program.

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 ($1,563 per month as of 2022) are financially eligible. The NJ FamilyCare website provides additional information and an application.

General Information
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Introduction to Insurance Split Application MedicaidMedicaid and How To Enroll
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Fully Insured PlansIn-Network ExceptionsEPSDT Medicaid Benefit
Medicaid and How To EnrollPrompt Pay LawTreatment When You Need It
Child-Only PlansTreatment When You Need ItMedicaid for Adults
Medicaid and ABA: Knowing Your Rights
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