Split Application Medicaid

January 23, 2023

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

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We often receive calls to our 800.4.AUTISM Helpline from families seeking Medicaid health coverage for their child with autism. Due to Medicaid’s income and asset thresholds, many families’ income or financial resources make them ineligible. In 2022, a family of four must make less than $36,908 in pre-tax income to remain eligible for NJ FamilyCare, the New Jersey Medicaid program. However, if the family has another child, and that child has no disability, there may be another option: Split Application Medicaid.

What Is Split Application Medicaid?

Split Application Medicaid is a type of Medicaid that covers a child with a disability, despite their parents’ financial ineligibility, so long as the child has a sibling who does not have a disability. Usually, Medicaid “deems” the parent’s income to each child.* Therefore, if a child’s parents make too much for the family to be eligible for Medicaid, the child would not be eligible on his or her own, either.

Under the split application analysis, parental income is deemed to the non-disabled child. As a result, the child with disabilities may meet the income eligibility requirements for Medicaid and receive health coverage under NJ FamilyCare (unless the child has substantial income of their own).

How Do I Get Split Application Medicaid?

To apply for Split Application Medicaid, parents should start by contacting their local county Board of Social Services. Parents should always mention that there is a child with a disability in the family and that they want to apply for a Medicaid “companion case” or make a split application. If the intake worker is not familiar with the spilt application, the family should kindly ask to speak to a supervisor.

Parents must apply for both children under the Medically Needy Program. “Companion case” means that another child in the family applies for Medicaid under the Medically Needy program at the same time that the child with a disability applies for NJ FamilyCare. This is where the name “split application” comes from.

The Disability Review section of the Division of Medical Assistance and Health Standards will then evaluate the child’s disability according to Social Security disability standards.

*Deemed is a technical word. In the context of Medicaid, income deemed to a child means that those funds are included as that child’s income, whether or not it’s actually available to or earned by that child.