Mainstreaming Medical Care

Beverly Roberts, Director

The Arc of New Jersey's Mainstreaming Medical Care Program promotes quality health care for people with developmental disabilities throughout New Jersey. Click here for the program brochure.


NEW! 
 
*Accessing DDD Services at age 21 -   2017 Fact Sheet This fact sheet will help you with the steps to follow when requesting access to certain services from DDD at age 21 and before leaving school.  Be prepared to access all available services from DDD at age 21 and after leaving school.

 

*SSI Eligibility Webinar
Supplemental Security Income (SSI) eligibility is determined on a month by month basis. If you or your loved ones receive benefits from Social Security, you have a legal obligation to report changes, which could affect eligibility for SSI benefits and Medicaid.

Hosted by The Arc of New Jersey Family Institute and presented by David Vinokurov, District Manager for the New Jersey Social Security Administration Office in Trenton, attendees learn how to report changes for your SSI benefits and avoiding SSI overpayments and underpayments.

Resources & links can be found in the Social Security Resource section below.


 

Dual-Eligibles

Individuals who have both Medicaid & Medicare

NEW! Frequently Asked Questions Fact Sheets

Below are ​our​ brand new frequently asked questions (FAQs) on dual eligibles with I/DD - persons who receive both Medicaid and Medicare.  Because this is such an important (but complicated) issue, the attached FAQs are divided into three sections:

Dual Eligibles - General Information

Dual Eligibles and Prescription Medication

Dual Eligibles and Special Needs Plans (D-SNPs)


 

Medicaid Resources

Clarification on the PPP program and a parent/guardian being employed to provide the PPP services

Please see below for an update from DDD pertaining to the new fiscal intermediary, Public Partnerships.  In particular, there has been some confusion recently with regard to the Personal Preference Program (PPP) and the Public Partnerships procedures.  Questions were raised as to whether or not there will be any changes in the individual's parent or guardian being able to continue to provide services through the PPP process.  It should be noted that PPP services are approved through the NJ Division of Disability Services (DDS) and the individual's Medicaid HMO.  (​The approval for ​PPP services ​is​ completely​ different from the self-directed services that are available through DDD.)

The good news is that parents/guardians can continue to provide PPP services for their son/daughter, as they have done in the past.   

This is the relevant wording​ on the issue of parents providing their son/daughter's PPP services, copied​ from the Division Update below:

​"​Clarification on Hiring a Parent/Guardian as a Self-Directed Employee (SDE) Under the New Fiscal Intermediary"

·  DDD: Individuals participating in the DDD Self-Directed Employee option had not been able to employ a parent, guardian or spouse to provide DDD services under the old fiscal intermediary (Easter Seals) and will not be able to employ a parent, guardian or spouse to provide DDD services under Public Partnerships.

·  PPP: Individuals participating in the DDS Personal Preference Program (PPP) had been able to employ a parent or guardian to provide PPP services under the old fiscal intermediary, and will continue to be able to employ a parent or guardian to provide PPP services under Public Partnerships.

If you are interested in further information on the Personal Preference Program, see this link:  http://www.state.nj.us/humanservices/dds/services/ppp/

                   

Helpful Information on NJ Medicaid:

The Arc of NJ's: Medicaid Eligibility Problem Form: (Revised January 2107) Family members and staff may use this form when a person with an intellectual and developmental disability is having difficulty obtaining Medicaid.

The Arc of NJ's: Medicaid HMO Problem Form Report:  Family members and staff may use this form if an individual is currently enrolled in a Medicaid HMO and is having difficulty obtaining a medical, dental, or behavioral health service that should be covered by the HMO.  This form can also be used with the HMO has reduced the approved number of hours of a service (e.g., person care assistant services or private duty nursing). 

Section 1634 of the Social Security Act - Disabled Adult Child (DAC) flyer: This important flyer, developed by the NJ Department of Human Services, is applicable for persons with a disability who have Supplemental Security Income (SSI).  When the individual's mother or father retires, or if the parent becomes disabled or dies, this flyer describes the process by which the "disabled adult child" (DAC) can continue to receive Medicaid. However, if the process described in this flyer is not followed, the DAC would likely lose Medicaid benefits and, therefore, access to DDD services would also be jeopardized. 

 

*NEW Application for ​ABD ​​Medicaid as a Disabled Adult Child (DAC):  Tips when completing the ABD Medicaid Application:

- ​When the application is completed, it should be brought to the Board of Social Services or mailed in.  Please ​keep​ a copy of the application.  If bring​ing​ it in, ask for a receipt that it was received.  If mailing, please do it return receipt.  

- The only income information that is required is the ​applying individuals income.  They don't need income information from anyone else in the household.​

 

Section 1619(b) of the Social Security Act - SSI and Continued Medicaid Eligibility: This important flyer, developed by the New Jersey Division of Developmental Disabilities, describes the process by which individuals who are employed and are eligible for Supplemental Security Income (SSI) may continue to be eligible for Medicaid coverage when their earnings are too high to continue to receive SSI.

LogistiCare:
LogistiCare became NJ's medical transportation broker in July 2009 and is now responsible for arranging through its provider network: upper-mode non-emergent Mobility Assistance Vehicles (MAVs), Ambulance service and lower-mode, livery service for Medicaid recipients in all counties. Read More...

Medicaid-Covered Transportation More Than 20 Miles from Home

Medicaid Coverage for "Thick It"                                

 

Health Insurance Through Affordable Care Act (Obamacare) 

Most people with I/DD have health insurance through Medicaid, Medicare, and/or a parent's private insurance.  However, anyone who is not able to access health insurance from those sources, can obtain it through the Affordable Care Act (ACA).  Below is a link for anyone that need help in applying for ACA insurance is available from organizations throughout New Jersey.  Once on the website,  enter your zip code and you will see the organizations that can assist in the process of applying for ACA health insurance.

HealthCare.gov - Find Local Help

A Guide to Assist NJ Residents' Selection of Health Insurance Plans: A Resource for Navigators and Community Assisters-  

Please note that this information is not applicable for people who are eligible for Medicaid (including persons who receive Medicaid expansion through the federal health care law).

The National Disability Navigator Resource Collaborative has released the first of several fact sheets entitled “Comparing Health Plans’ Benefits and Coverage Summaries.” This fact sheet is intended to inform navigators and other enrollment specialists about what people with disabilities need to look for in the Summary of Benefits and Coverage. Read More...

                


 

Social Security Resources

 

Fact Sheets:

Division of Developmental Disabilities Medicaid Eligibility for the Supports Program

Persons with Intellectual and Developmental Disabilities (I/ HealthDD) Who Have Medicaid and Private Insurance

Updated Fact Sheet on Supplemental Security Income (SSI)

 

Understanding Supplemental Security Income (SSI) Reporting Responsibilities

Supplemental Security Income (SSI) eligibility is determined on a month by month basis. If you or your loved ones receive benefits from Social Security, you have a legal obligation to report changes, which could affect eligibility for SSI benefits and Medicaid. Hosted by The Arc of New Jersey Family Institute and presented by David Vinokurov, District Manager for the New Jersey Social Security Administration Office, attendees will learn how to report changes to your SSI benefits and avoiding SSI overpayments and underpayments. 

In preparation for this presentation, please go to www.socialsecurity.gov/myaccount and sign up today for your personal MySSA account. Download or print your Statement so that you have it with you during the Webinar. There also will be a question-and-answer segment.

Background:
In order to receive DDD services, individuals with intellectual and developmental disabilities (I/DD) must have Medicaid*. Many individuals with I/DD become Medicaid eligible when they receive Supplemental Security Income (SSI). Medicaid begins automatically when a person with I/DD is approved for SSI. Families often have questions about the SSI income and asset requirements. A family's understanding these requirements is very important because failure to properly report income and assets for a person with I/DD can prevent the individual from becoming eligible for SSI, and can also result in termination of SSI benefits that were previously received. 

*Occasionally,individuals with I/DD qualify for an exception to DDD's Medicaid requirement. This exception is referred to by DDD personnel as "Non-DAC". For further information on "Non-DAC" status, please contact Beverly Roberts at The Arc of New Jersey - broberts@arcnj.org.

Slides from the presentation on September 26, 2017

Links and Flyers Discussed During This Webinar

 

Applying for SSI & Medicaid:

~ Part 1 & Part 2 ~

Downloadable PDF Documents:


 

Healthy Times Newsletter

NEW! Summer/Fall 2017

      In this Issue:

  • IDD Toolkit- Online Resource for Health Care Providers and Caregivers
  • Medicare and Medicaid: Dual Eligibles- FAQs
  • Free Support Services for Families When a Loved One with I/DD has Alzheimer's Disease, By Leone Murphy, APN
  • Lunch & Learn Webinar: Understanding Supplemental Security Income (SSI) Reporting Responsibilities, Sept 26, 2017
  • Highlights from The Arc of New Jersey's 28th Annual Conference 
  • New Jersey Self-Advocacy Project - Healthy Relationships Workshop Series
  • Caregiver Wellness, A Free Self-Care Program for Caregivers of Individuals with a Developmental Disability and Mental Illness
  • Save the Date - The 29th Annual Conference on Medical Care for Persons with Intellectual & Developmental Disabilities- June 1, 2018

Past Healthy Times Newsletters: 

Winter 2017

Summer 2016 

Winter 2015

Fall 2015


 

The 28th Annual Conference on Medical Care for Persons with Intellectual & Developmental Disabilities 

                                  June 2, 2017

More than 330 people and 32 exhibitors filled the Westin Princeton at Forrestal Village for the 28th Annual Conference on Medical Care for Persons with Intellectual and Developmental Disabilities on Friday, June 2. The conference is geared toward those interested in providing quality healthcare to individuals with intellectual and developmental disabilities.The event included opening remarks from DHS Commissioner Elizabeth Connolly, an update from Meghan Davey, Director of the NJ Division of Medical Assistance and Health Services, and Darlene Yannetta, Director of Provider and Constituent Relations for the NJ Division of Developmental Disabilities, a morning and afternoon keynote presentation, and a number of workshops covering a broad range of healthcare topics.

The IDD Toolkit, which was presented in our morning keynote presentation by Janet Shouse, Program Coordinator for the IDD Toolkit at the Vanderbilt Kennedy Center in Nashville TN, can be found at www.IDDtoolkit.org and is also featured in our Summer/Fall Healthy Times Newsletter.

Photos from the conference can be viewed here.

 


The 2017 Medicare Part D Changes for Persons Who Have Both Medicare and Medicaid

Beginning on January 1, 2017, there will be changes in Medicare Part D, the federal drug benefit that is used by most dual eligibles (persons who have both Medicaid and Medicare) to obtain their prescription medications. 

This webinar is for everyone who wants to know about Medicare Part D for the dual eligibles, including employees of provider agencies serving people with Intellectual and Developmental Disabilities (I/DD), staff from DDD, family members, and health care professionals. The webinar will discuss the details of the changes and how they will affect individuals with developmental disabilities who are eligible for both Medicare and Medicaid.

PDF Slides- 2017 Medicare Drug Benefit Changes for Dual Eligibles (Bev Roberts)

PDF Slides- Navigating Drug Plan Finder (Mary McGeary)

Important Information on the 2017 Medicare Part D Drug Plan for Dual Eligibles

2017 Medicare Part D Stand Alone Prescription Drug Plans Chart for NJ


 

Health and Wellness Material:

Cancer Screening and Risk Reduction
The Arc of New Jersey and its Mainstreaming Medical Care Program have developed an initiative called Let's Talk About Health, which is a comprehensive effort to develop educational programs and materials that address health care issues of people with developmental disabilities in accesible formats. Projects to date include the following:
Health Screening and Risk Reduction for Breast Cancer
Health Screening and Risk Reduction for Colon Cancer
Health Screening and Risk Reduction for Prostate Cancer

Diabetes Materials
Launched in 2006 with funding from The Horizon Foundation for New Jersey, The Arc of New Jersey’s Diabetes Awareness and Education Project has produced materials intended to educate individuals with developmental disabilities and their caregivers regarding important steps that can be taken toward the prevention and control of Diabetes, including changes in diet and exercise habits and regular monitoring by a health care professional. Read More...

To Order a Copy of the Diabetes Booklet and/or Educational Film, Click Here.

Diabetes Video Guide and Booklet (English Version):
Diabetes Booklet
Video Part 1
Video Part 2

Diabetes Video Guide and Booklet (Spanish Version):
Diabetes Booklet
Video Part 1
Video Part 2

Women's Health Project
Order Form for Women's Health Project Materials

Adult Personal Health Record and Medical History Form
With a grant from the New Jersey Council on Developmental Disabilities, The Arc of New Jersey has developed a new Adult Personal Health Record and Medical History Form, available in both English and Spanish. Completed by a family member or caregiver, the form provides accurate documentation of the most important aspects of a person’s medical history. The original remains with the consumer or caregiver; a copy can be provided to the consumer’s primary health care providers; and copies can be brought when the consumer has other health appointments, such as a clinic or emergency room.
Adult Personal Health Record and Medical History Form: English
Adult Personal Health Record and Medical History Form: Spanish