"Your Needs Are Our Concern"
WHAT IS MEDICAID?
Medicaid is an entitlement program, created by Congress in 1965 as Title XIX of the Social Security Act, which provides health insurance for certain groups, or categories, of very low-income Americans. Depending on the particular Medicaid program, payment may be made for hospital, doctor, prescription drug, nursing home and other healthcare needs.
Medicaid is funded jointly by the states and the federal government. New Jersey has participated in the program since 1970. Today, New Jersey Medicaid is the largest social services program in state government. It provides for the healthcare needs of more than 600,000 people.
To be eligible for New Jersey Medicaid, a person must meet these general requirements:
Resident of New Jersey
U.S. Citizen or qualified alien (most immigrants who arrived after August 22, 1996 are barred from the program for five years)
Meet specific standards for financial income and resources
Applications for most Medicaid programs are available through any of MCDSS offices. In New Jersey the county of residence determines eligibility for Medicaid.
Within New Jersey Medicaid are also a number of special programs designed to meet the specific medical needs of certain groups of people who would not otherwise qualify for the program.
WHAT PROGRAMS MAY I APPLY FOR AT MCDSS?
NJ FamilyCare is a federal and state funded health insurance program created to help New Jersey’s uninsured families have affordable health coverage. It is not a welfare program. NJ FamilyCare is for hard working families and single adults who cannot afford to privately pay the high cost of health insurance. Eligibility is based on family size and monthly income, assets are not considered when determining eligibility.
Who is eligible?
Children up to age 19. Eligibility is based on family size and monthly income. Only monthly income, not assets, is considered for eligibility.
NJ FamilyCare is no longer accepting applications for parents/caretakers.
What does it cover?
NJ FamilyCare is a comprehensive health insurance program that will provide many if not all of your health care needs. A sample of the services provided by NJFC are: physician services, preventive health care, emergency medical care, inpatient hospital services, outpatient hospital services, laboratory services, prescription drugs, dental services, emergency transportation, mental health services, plus many more.
Each county has at least two and up to six Health Maintenance Organizations (HMOs) to choose from that will help you get these services. Depending on you or your families’ yearly income and age, there may be restrictions on certain services. If you are looking for a certain service or would like to know if that service is available to you or your family through NJ FamilyCare, please contact the HMO customer services 800 numbers.
Applications for FamilyCare can be completed at any MCDSS office. If you are unable to visit our offices, call 800-431-6300 for an application to be mailed to you.
New Jersey Medicaid covers persons who are age 65 years or over and persons determined blind or disabled by the Social Security Administration or by the division of Medical Assistance and Health Services. The individual must be a resident of New Jersey and a citizen of the United States or lawfully admitted for permanent residence. Care may be in an institution or in the community.
AIDS COMMUNITY CARE ALTERNATIVES PROGRAM (ACCAP)
ACCAP is available for persons diagnosed as having AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex). Persons must meet Social Security Disability criteria, as well as Medicaid income and resource guidelines. Persons must require the level of care provided by a nursing home, but may choose to remain in the community.
An individual is eligible for community Medicaid in New Jersey if income and resource (asset) limits are met.
In order to qualify for payment of institutional benefits, for example nursing facility care, under the Medicaid program in New Jersey, an applicant must meet not only the financial criteria, but also the medical necessity requirements. Each of these eligibility processes is complex and must be evaluated according to the applicant’s individual circumstances. Applications are taken at any office of MCDSS.
Medically Needy: Provides certain medical benefits for persons whose income and resources are too high to qualify for regular Medicaid but do not have enough to pay their medical bills. Four categories are considered for the Medically Needy program: pregnant women, dependent children under 21 years of age, persons 65 years of age or older and individuals who are blind or disabled. Medically Needy applications are taken at all three MCDSS offices.
Community Care Program for the Elderly & Disabled (CCPED) pays for home care services to help eligible individuals continue to live in the community rather than in a nursing home. Applicants must be age 65 or older or receiving Social Security disability benefits and must meet financial and medical eligibility guidelines. Persons under age 18 are not eligible. New to the ECO is the Caregiver Assistance Program (CAP) and the Assisted Living/Alternate Family Care program. Both of these provide enhanced service packages to persons needing more care than what is available under CCPED, but where increased service will prevent nursing home placement. Visit any MCDSS office to complete any of these ECO applications.
Medical Transportation to and from medical appointments is available to NJ Family Care/Medicaid recipients. To arrange Medical Transportation call Logisticare 1-866-527-9933.
(Medical Transportation is not administered by the Monmouth County Division of Social Services)
Charity Care offers payment assistance for hospital care for New Jersey residents who are ineligible for health care coverage through private or governmental programs. Eligibility is based on income and asset limits.
Charity Care applications are available through hospitals and some health care provider agencies. MCDSS does not take Charity Care Applications.
Pharmaceutical Assistance to the Aged & Disabled (PAAD), Lifeline, and Hearing Aid Assistance to the Aged & Disabled (HAAAD) are three state-funded programs with similar eligibility guidelines.
The Pharmaceutical Assistance to the Aged & Disabled (PAAD) program helps eligible New Jersey residents pay for prescription drugs, insulin, insulin needles, certain diabetic testing materials and syringes, and needles for injectable medicines used for the treatment of multiple sclerosis. Only drugs approved by the Food and Drug Administration are covered. Drugs purchased outside the State of New Jersey are not covered, nor is any pharmaceutical product whose manufacturer has not agreed to provide rebates to the State of New Jersey.
Lifeline is a utility assistance program that offers a money benefit for electricity and natural gas customers as well as tenants whose utility bills are included in their rent.
Hearing Aid Assistance to the Aged and Disabled (HAAAD) provides reimbursement of costs of a hearing aid. If you receive Medicaid or have insurance coverage you are only eligible if your plan has limited coverage.
To be eligible for PAAD, Lifeline, and (HAAAD) the following requirements need to be met:
New Jersey resident.
Income guidelines set by law.
At least 65 years of age, OR at least 18 years of age and receiving Social Security disability benefits. If under age 65 and receiving Social Security Disability benefits on behalf of someone else, there is no eligibility, you are NOT eligible.
The income limit will increase each January by the amount of the Social Security cost-of-living increase.
MCDSS does not provide these applications. Applications for these three programs are available from:
P.O. Box 715
Trenton, NJ 08625-0715
CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND
The Catastrophic Illness in Children Relief Fund was established by legislation to provide financial assistance for families whose children have experienced an illness or condition which is not covered by insurance, state or federal programs or other sources. Payments are usually made directly to providers or vendors.
In order to qualify, the child who incurred the expense must have been under 18 years of age at the time the expense was incurred and the family of the child, must have resided in New Jersey for at least three months prior to that same date. There are restrictions on eligible expenses and there are income guidelines.
For further information, call 1-800-335-FUND.
MCDSS does not administer this program.
The Monmouth County Health Department sponsors an Immunization Clinic at the Monmouth County Division of Social Services in Freehold, New Jersey. The Immunization Clinic is a free program for Monmouth County residents who do not have any health insurance. The clinic is open on Mondays and Tuesdays from 9 a.m. to 12 noon and 1:30 to 3:30 p.m. No appointment is necessary. Previous immunization records are required before immunizations may be given. Children must be under the age of 18. Please call (732) 294-5458 for more information.
VOLUNTEER PILOTS ASSOCIATION
Do you or someone you know need to travel several hundred miles for medical treatment? If you cannot afford the cost of commercial transportation, but cannot afford not to make the trip, call the Volunteer Pilots Association. The Association is an all-volunteer non-profit group whose sole mission is to provide free air transportation to people needing to get from their home area to a distant location, and back, for medical treatment or evaluation.
The VPA serves residents of Pennsylvania, Ohio, New Jersey, Southern New York, Virginia, West Virginia, Maryland and Delaware. The VPA fllies to locations within a 500-mile radius of Pittsburgh. Missions outside this radius can be coordinated with other volunteer flying organizations.
THE VOLUNTEER PILOTS ASSOCIATION also provides free air transportation for persons who need to travel several hundred miles for medical treatment. For further information, see below.
Requirements for acceptance by the VPA:
- Assurance by a social worker or clergy of a genuine financial need.
- Certification by a doctor that the patient is ambulatory and fit to fly in a general aviation aircraft without medical assistance. The VPA volunteers are pilots, not medical personnel, and are not trained to provide medical assistance.
- Passengers must be able to sit upright and wear seat belts during the flight.
- One or two companions may accompany patients if the assigned aircraft has sufficient room for them.
- Baggage space in small aircraft is always limited, so passengers must travel lightly.
- Missions generally originate at airports near the patient’s home.
For further information contact:
Volunteer Pilots Association
P.O. Box 471
Bridgeville, PA 15017
Phone (412) 221-1374