Medicaid Managed Care for Children
with Special Needs in New Jersey

Fact Sheet 5: Welfare, Supplemental Security Income, Medicaid

When we talk about Medicaid managed care, some unfamiliar words may come up.  Go to the “Important Terms” fact sheet  to look up highlighted words.  This will help you learn how to “speak the language” of managed care.

Parents of children with special needs who receive welfare support or whose children receive Supplemental Security Income (SSI) often are concerned about what will happen to their Medicaid health insurance if their children become ineligible for SSI or welfare. 

In 1997, federal welfare and SSI regulations changed due to passage of the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA). 

This meant that standards for eligibility for these programs became stricter, and some people who had formerly qualified for them no longer were eligible.  

If your family has lost eligibility for welfare or your child has lost eligibility for SSI, this does not necessarily mean that your child has lost eligibility for Medicaid.

WELFARE, SSI, AND MEDICAID IN NEW JERSEY

New Jersey’s welfare program for families is known as Work First New Jersey/ Temporary Assistance to Needy Families (WFNJ/TANF).  The county welfare agency in each county administers the WFNJ/TANF program.

Supplemental Security Income (SSI) is a program administered by the federal Social Security Administration (SSA), under which people with limited income and resources who are blind or disabled (and persons 65 or older) receive maintenance payments from SSA and supportive services through the Board of Social Services in each county.  In New Jersey, a state supplement provides additional funds to persons eligible for SSI.

Medicaid is a government program that provides free medical assistance for qualified beneficiaries.  New Jersey’s Medicaid program is called New Jersey Care 2000+, or Medicaid Managed Care.  In New Jersey, most children eligible for SSI are automatically eligible for and will be enrolled in Medicaid.

HOW MIGHT MY CHILD LOSE WELFARE OR SSI ELIGIBILITY?

Welfare:  If your family income or resources change, or if you reach the 5-year time limit on your welfare benefit, your family can become ineligible for NJWF/TANF. 

SSI:  A Disability Determination Services Team made up of a trained disability examiner and a physician or psychologist determines SSI eligibility.  To be eligible, your child must have a physical or mental condition(s) that can be medically proven and which results in marked or severe functional limitations; and the condition(s) must have lasted or be expected to last at least 12 months or end in death.

If your child has a disability which has a chance of improvement, eligibility will be reviewed once every 3 years to see if her condition has improved; or if your baby receives SSI because of low birth weight, eligibility will be reviewed no later than her first birthday.  At either of these times, it may be determined that her condition has improved enough that she no longer qualifies for SSI. 

Another way SSI eligibility could be lost is through an increase in family income or resources. 

Anytime your child is determined to no longer be eligible for SSI, you will be notified of the decision in writing and you have the right to appeal within 60 days of your receipt of the notice.  You may request that your child’s SSI payments continue during the appeal within 10 days of your receipt of the notice, but if your child is still found ineligible for SSI, the continued benefits will be considered an overpayment that you will be required to pay back. 

Remember, eligibility for Medicaid is not automatically lost
if your family or child is no longer eligible for SSI or welfare!

WHAT CAN I DO IF I HAVE A PROBLEM WITH LOSS OF BENEFITS?

First contact your county welfare agency to ask what you can do. 

If county welfare cannot help you, you can contact either:

Legal Services of New Jersey at their statewide Legal Hotline, 1-888-LSNJ-LAW (1-888-576-5529) or the local Legal Services program in your county. Services are provided at no charge, but you must be financially eligible to qualify and representation is not guaranteed.  If you are hearing impaired or unable to contact them during business hours, you may e-mail your inquiry to legalhelp@lsnj.org .  Website:  http://www.lsnj.org/ ;

or

The Community Health Law Project, a non-profit legal aid society dedicated to serving the legal needs of persons with disabilities and the elderly throughout New Jersey. Through negotiation, litigation and advocacy, the CHLP removes discrimination, protects rights, and preserves independence and quality of life.   Staff members are based in four regional offices and an administrative unit, and include attorneys and social service advocates who are experts in public entitlements like Supplemental Security Income (SSI), Social Security Disability Benefits, Welfare, Emergency Assistance, Medicaid, Medicare, and other Health Insurance.  Phone: (973) 275-1175 / FAX (973) 275-5210

Resources for information about welfare, SSI, and Medicaid include the state Medicaid Hotline, 1-800-356-1561 (toll-free)

or

your local county welfare agency
(find the phone number in the blue pages of your phone book)

LEGAL SERVICES OF NEW JERSEY
1-888-576-5529 (TOLL-FREE)

MANAGED HEALTH CARE CONSUMER ASSISTANCE PROGRAM
1-888-838-3180 (TOLL-FREE)

For other questions about Medicaid and children with special health care needs in New Jersey, see the Family Voices Resource List or the Family Voices Fact Sheets on Medicaid Managed Care.

If your family loses eligibility for welfare, also known as Work First New Jersey/
Temporary Assistance for Needy Families (WFNJ/TANF),
you or your child with special needs may still be eligible for Medicaid.

If your child with special needs loses eligibility for Supplemental Security Income (SSI),
he may still be eligible for Medicaid.