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Everyone with IDD who has DDD services must have NJ FamilyCare/Medicaid. During the COVID pandemic, no one was terminated from Medicaid -- even if they were no longer eligible. However, the automatic continuation of Medicaid coverage, which has been in effect for three years, is ending, and Medicaid redetermination applications will be required. The process of requiring a Medicaid redetermination application has been referred to as Medicaid "unwinding". Even if nothing has changed for individuals with intellectual and developmental disabilities (IDD), all NJ FamilyCare/Medicaid enrollees will be required to have a "redetermination" of their Medicaid eligibility, and this process will start in April 2023.
There is an exception to the requirement that everyone who has NJ FamilyCare/Medicaid will have to do a Medicaid redetermination: Individuals who currently receive Supplemental Security Income (SSI) and Medicaid will not receive a Medicaid redetermination application. However, it is possible that individuals who receive SSI could receive a redetermination notice from Social Security. Therefore, it is important to respond promptly if Social Security sends a letter requiring a redetermination.
The NJ FamilyCare/Medicaid redetermination applications will be mailed during a 12 month period, and 1/12th of these applications will be mailed each month, between April 2023 and March 2024. Please see the pie chart below, which illustrates that only a small portion of the redetermination applications will be received in April, whereas the rest of these applications will be mailed in May 2023 thru March 2024.
The Arc of New Jersey recently set up a new page on our website, to make it easier to access the most up-to-date information on Medicaid unwinding, including webinar recordings. As we become aware of additional information, we will post it in this section of our website. Click here to see the current information on Medicaid unwinding and the redetermination process.
https://nj.gov/humanservices/dmahs/staycoverednj/toolkit/
https://www.arcnj.org/programs/mainstreaming-medical-care/medicaid-unwinding.html
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!!NEW!! – Message from the Division of Medical Assistance and Health ServicesThe Division is re-broadcasting the below message from the Division of Medical Assistance and Health Services (DMAHS). The message explains that beginning April 1, 2023 all States, including New Jersey, are required to resume their Medicaid Eligibility Processes. The Division recommends that stakeholders review this material, especially the Frequently Asked Questions found at the Community Toolkit link below.
Dear NJ FamilyCare community,
I hope you have enjoyed a happy and healthy holiday season. As many of you know, we had been anticipating an announcement from the federal government about the end of the COVID-19 Public Health Emergency (PHE). Late in 2022, we began to hear that Congress might separate the Medicaid continuous enrollment requirement from the ongoing PHE – and they in fact did so in late December, in the omnibus spending bill signed into law by President Biden on December 29, 2022. As a result, while the PHE continues, states are now required to resume Medicaid eligibility processes beginning April 1, 2023.
We are anticipating guidance from the federal Centers for Medicare & Medicaid Services in early January, and we will be prepared to share an update with you at our February 1 meeting of the Medical Assistance Advisory Council. We will also be updating our StayCoveredNJ website, removing references to the end of the PHE and clearly stating the April 1 date for when eligibility processes will resume. Please visit our Community Toolkit page for posters in English, Spanish, and 19 other languages.
In the meantime, here are the two most important things for our NJ FamilyCare members to know:
- Make sure NJ FamilyCare/Medicaid has your correct mailing address
- Members can confirm or update their contact information by calling NJ FamilyCare at 1-800-701-0710 (TTY: 711). NJ FamilyCare will use this information to communicate with members about their healthcare coverage.
- Respond to mail from NJ FamilyCare/Medicaid
- Members need to look for and respond to mail from the State of New Jersey or their local County Board of Social Services. If NJ FamilyCare requests information, they need to respond right away to avoid a gap in their NJ FamilyCare coverage.
On behalf of the whole DMAHS team, I wish you happiness and health in 2023. We look forward to working together with you to serve people the best way possible in the months ahead!
Visit the Division of Medical Assistance and Health Services website Click Here
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When the COVID pandemic began in March, 2020, the federal government declared a public health emergency (PHE). The PHE is still in effect as of early December when this email was prepared. Because of the PHE, no one should have received a Medicaid termination notice for any reason -- even if the Medicaid beneficiary has more resources than the allowable maximum.
However, at some point (possibly in mid-April, 2023) the PHE will officially end, and then "Medicaid unwinding" will begin.The term Medicaid unwinding describes the process that NJ Medicaid will use to determine whether individuals who have been receiving NJ FamilyCare/Medicaid are eligible to continue receiving Medicaid. Therefore, when the PHE has ended, NJ Medicaid will mail redetermination paperwork to everyone who has NJ FamilyCare/Medicaid, including individuals with intellectual and developmental disabilities (IDD). It should be noted that this redetermination process will be for people who have NJ Medicaid, not for those who have SSI and Medicaid.
Some individuals with IDD may receive renewal applications from NJ Medicaid now, even though the PHE has not ended. It is always important to respond promptly when receiving a Medicaid renewal appication.
It is important to notify NJ Medicaid if there has been a change of address. If the Medicaid beneficiary has moved since March, 2020, families of Medicaid enrollees with IDD should be certain that NJ Medicaid has the up-to-date address on file. If you don't know whether Medicaid has the correct mailing address, please contact the call center for NJ FamilyCare/Medicaid at 800-701-0710. If NJ Medicaid does not have your current mailing address, please provide it.
After the PHE has ended, and the NJ Medicaid redeterminataion process is underway, anyone who has more than the allowable amount of resources is at risk for a Medicaid termination! Therefore, it is important to pay attention now to the amount of resources that Medicaid beneficiaries with intellectual and developmental disabilities (IDD) have. Caregivers should be certain that the resources (assets) do not exceed the allowable Medicaid limits. Please see below for additional information.
1. For most individuals with IDD enrolled in New Jersey's Aged, Blind and Disabled (ABD) Medicaid program, the maximum amount of allowable resources is a total of only $2,000. The allowable exceptions are having an ABLE account or a special needs trust (SNT) as long as it was prepared by an attorney who has expertise in writing an SNT that is in accordance with NJ Medicaid regulations.
2. Enrollment in NJ WorkAbility Medicaid is another exception to the $2,000 resource limit. The current NJ WorkAbility regulations allow individuals with disabilities who are employed part-time or full-time to have up to $20,000 in resources. People enrolled in NJ WorkAbility Medicaid are also permitted to have a retirement account (e.g., IRA or 401k).
3. Another exception on the $2,000 maximum in resources occurs if a person with IDD has recently received a "back payment" from Social Security. The recipient of a back payment from Social Security is permitted nine (9) months from the date it is received to spend it down to $2,000.
4. For anyone with IDD who has resources that exceed, or are likely to exceed, the Medicaid resource limits mentioned above, there are a few options:
· A spend-down for items that are needed for the individual with IDD, such as new computer equipment, therapies that are not otherwise covered, etc. All of the spend-down expenditures should be clearly documented and please keep all receipts.
· If the Medicaid enrollee has resources that are in excess of the Medicaid maximum amount, then opening an ABLE account may be appropriate (see below for more information on ABLE accounts).
· If the Medicaid enrollee's resources are higher than the amount that can be deposited into an ABLE account ($16,000 per year), then a Special Needs Trust (SNT) should be considered. If a special needs trust will be prepared, it is strongly recommended that the parents contact an attorney with extensive experience and a thorough understanding of the Medicaid SNT regulations.
5. ABLE accounts are special, tax-advantaged savings accounts for persons with disabilities. The acronym ABLE stands for "Achieving a Better Life Experience." To be eligible for an ABLE account, the onset of the disability must have occurred before the age of 26. Deposits are limited to a total of $16,000 per calendar year. Having an ABLE account does not jeopardize one's eligibility for Supplemental Security Income (SSI) or NJ Medicaid. For information on NJ ABLE, see this website: https://savewithable.com/nj/home.html Additional information on ABLE accounts is available from the ABLE National Resource Center: www.ablenrc.org The Arc of New Jersey Family Institute has developed a fact sheet, which provides a helpful summary about ABLE accounts.
Whenever the public health emergency (PHE) is scheduled to end, we anticipate receiving 60 days' notice. Whenever we receive that notification, I will distribute the information to everyone on my listserv. If you did not receive this email directly from The Arc of New Jersey, and you want to sign up for this listserv, you can easily do that on my website: www.mainstreamingmedicalcare.org.
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This provides several resources developed to assist anyone who is seeking Medicaid
MCO dental care for a person with IDD. All of the following resources were developed by the NJ chapter of the American Academy of Pediatrics (AAP) with a grant from the Inclusive
Healthy Communities (IHC) program, funded by the NJ Division of Disability Services (DDS).
1. Fact sheet: What to ask when contacting a dental office, in English and in Spanish.
This guide will help parents and other caregivers of children and adults with intellectual and developmental disabilities with questions to ask when calling a dental office for an appointment. Download the English version here and the Spanish version here.
2. Dental benefits for individuals with IDD - Medicaid Managed Care Organization webinar slides.
See the slides from a webinar that focused specifically on dental benefits for individuals with
IDD enrolled in a Medicaid managed care plan. The webinar began with information that is applicable to all of the Medicaid MCOs, followed by slides from each MCO: Aetna Better
Health, Amerigroup, Horizon NJ Health, United Healthcare Community Plan, and WellCare. Slides can be viewed here.
3. Dental Directory information from each Medicaid Managed Care Organization.
Each NJ Medicaid Managed Care Organization has a network of providers with expertise in providing dental care to individuals with IDD. See the link for the information that each Medicaid MCO provided on their dental providers who have expertise in providing dental care to members with IDD.
· Aetna Adults - https://bit.ly/aetnabetterhealthadults
· Aetna Children - https://bit.ly/aetnabetterhealthchildren
· Amerigroup - https://client.libertydentalplan.com/amerigroup/anthemnj
· Horizon - https://www.horizonnjhealth.com/membersupport/resources/dental-guide-for-idd-members
· United - https://bit.ly/dentalunitedhealthcare
· Wellcare - https://bit.ly/wellcarelibertydental
May 5, 2022: Human Services Announces New Help Line for Caregivers of Adults with Intellectual and Developmental Disabilities
The Social Security Administration (SSA) has just released a new online tool that applicants and individuals assisting applicants can use to request an appointment to apply for SSI benefits. This request creates a protective filing date – which is used to determine when an individual can start receiving SSI benefits – as long as the SSI application is submitted within 60 days.
An individual only needs to provide basic information to make the online request. After the individual submits the request, SSA will schedule an appointment to apply for benefits, which will take place over the phone, and let the individual know of the appointment date within 14 business days. "Priority life circumstances” – such as homelessness, a terminal illness, or recent release from incarceration – can be indicated in the application. If one of these priority life circumstances is indicated in the application, an SSA employee will attempt to contact the applicant by phone within three business days to either apply for SSI benefits then or to schedule an appointment to apply.
More detailed policy guidance about the online tool can be found in EM-22015.Additional resources from the National Center on Law and Elder Rights (NCLER):
- SSI Basics Training Video
- SSI Basics Issue Brief
- Pandemic-Related Disaster Assistance for SSI Recipients Training Video
- Practice Tip: Important Change for SSI Recipients and Applicants
- Social Security Overpayments and Low-Income Clients Training Video
Slam the Scam – Protect Against Social Security Imposter Scams
The Inspector General for the Social Security Administration (SSA) has designated March 10, 2022 as National “Slam the Scam” Day—an outreach campaign to raise public awareness of Social Security scams and other government imposter scams. This is part of National Consumer Protection Week, March 6 - 12, 2022. We are asking you to share information about “Slam the Scam” Day with your clients, friends, and family.
In 2021, the Federal Trade Commission (FTC) received over 396,000 complaints of government imposter scams. Nearly 9% said they lost money to a scammer—more than $442 million. To prevent further losses, we urge everyone to use caution when receiving calls from someone claiming to be from a government agency.
Here are a few things to remember and share with clients, friends, and family. We will never:
· Threaten arrest or legal action if someone does not immediately send money to resolve an overpayment.
· Promise to increase benefits or resolve identity theft issues for a fee or by moving money into a protected account.
· Require payment with a retail gift card, prepaid debit card, cryptocurrency, wire transfer, internet currency, or by mailing cash.
· Send text or email messages that contain personal information.
Our scam prevention message is simple:
· Hang up on suspicious calls from “government officials” calling about a problem with your Social Security number or account.
· NEVER make payments with gift cards, wire transfers, or by mailing cash.
· Report Social Security scams to OIG.SSA.GOV.
· Report other scams to reportfraud.ftc.gov.
Visit OIG’s Press Kit for additional resources related to “Slam the Scam” activities. Read and share our Scam Awareness Toolkit and Scam Alert infographic.
Together, we will remain vigilant against government imposter scams and help protect people from fraud.
Six free resources are now available for download in Spanish to help people with intellectual and developmental disabilities (IDD) and their families plan for the future.
These resources cover a variety of topics related to decision-making and financial planning, including:
- Supports available to help people with IDD make decisions
- Preparing for unexpected changes in a person’s ability to make decisions
- Common myths about guardianship and people with IDD
- Tips on how to save money for the future
- Resources to consider when creating a financial plan
- When to use a Special Needs Trust or ABLE Account
Download these resources now and share them widely with the Spanish speaking families in your network!
And if you need something,
find out how WRIC can help you.
Check out our website,
for ongoing Programs, Victim Support, Meditation, Resume prep, Legal Consults, Career Closet appointments, ESL Classes, Shared Housing and emotional support and more.
