Medicaid Eligibility

The Division is able to provide extensive services to over 22,000 individuals only because the federal government provides matching funding for Community Care Program (CCP) and Supports Program (SP) services. Receiving this funding requires that the individual, provider and service meet all state and federal Medicaid requirements. For this reason, enrollment in the CCP or SP with an NJCAT tier budget requires that individuals maintain Medicaid eligibility.  

Because there are different ways to initiate the Medicaid eligibility process, it is important to understand how you can become eligible.

If you are receiving or wish to receive DDD services and Medicaid eligibility is denied or terminated, please complete DDD's Medicaid Eligibility Troubleshooting Form and submit it, along with a copy of the Medicaid denial letter, to DDD's Medicaid Eligibility Help Desk by email: DDD.MediEligHelpdesk@dhs.nj.gov, or by mail:

NJ Division of Developmental Disabilities
1B Laurel Dr.
Flanders, NJ 07836
ATTN: Medicaid Eligibility Help Desk

New Jersey residents who receive SSI from the federal Social Security Administration (SSA) are automatically eligible for Medicaid. Additionally, the Division’s fact sheets on SSI benefits and SSI Continued Medicaid Eligibility (1619b) provide detail on how program rules protect Medicaid eligibility even if your income rises above certain thresholds.

SSA SSI is a monthly benefit paid by the federal government to adults with disabilities who have limited income and resources and is recommend for those who turn 18 years of age and expect to pursue DDD services. You can apply for SSI online. It may be helpful to review the Division’s fact sheet on Supplemental Security Income versus Social Security Disability Insurance.

The monthly benefit amount eligible individuals can receive is based, in part, on their income (once an individual turns 18, the SSA no longer counts parental income and resources). It is very important that those receiving a monthly SSI benefit report up-to-date wage information to the SSA.

If you are already receiving monthly SSI or SSDI benefits and you are age 18 or older, you can create an online My Social Security account.

If you have a monthly income or financial resources that are above SSI limits, you can still apply for New Jersey Medicaid by visiting your County Board of Social Services. Please review the Medicaid ABD Checklist to make sure you know what documents to bring when applying.

An individual meeting the criteria below may qualify for Medicaid as a Disabled Adult Child under Section 1634 of the Social Security Act:

  • Is at least 18 years of age,
  • Has blindness or a disability which began before the age of 22,
  • Has been receiving SSI based on blindness or disability, and
  • Has lost SSI due to the receipt of Social Security benefits on a parent’s record due to the retirement, death or disability of a parent (SSDI).

Eligibility for Medicaid may continue as long as the person is determined blind or disabled and certain income and resource limits are met. The Division’s DAC Fact Sheet includes detailed information on DAC status and how it relates to Division program eligibility.