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.
FIDE SNP enrollment will be voluntary - not mandatory!
We are delighted to announce that the New Jersey DHS has decided to eliminate this proposal from the Comprehensive Medicaid Waiver. Now, instead of a mandatory enrollment, dually eligible individuals will have a CHOICE about whether to enroll in a FIDE SNP.
Throughout the last few months, The Arc of New Jersey took a leadership role on this important issue, with a wide dissemination of our Action Alert, which included information on the FIDE SNP proposal. In addition, we raised our concerns on this matter to DHS representatives during a listening session in August. We have been told that DHS received many comments on the proposed Waiver, and a large number of parents with adult children with I/DD expressed their strong concern about the proposal for mandatory enrollment of dual eligibles into a FIDE SNP. Your letters and e-mails were very powerful in convincing NJ DHS to change this proposal! We thank NJ DHS for their responsiveness to our concerns and for making this important change. The Waiver was recently submitted to the federal Centers for Medicare and Medicaid Services (CMS).
As we mentioned in the e-mails that were circulated over the summer, a “FIDE SNP” is a Medicare managed care plan. If individuals who have both Medicare and Medicaid enroll in a FIDE SNP, they will be restricted to seeing only the physicians and other providers who are in the network of that managed care plan. If these individuals needed to see a physician who is not affiliated with that managed care plan, they would be required to pay the full cost of the physician’s bill.
Enrolling in a FIDE SNP continues to be a choice for all dual eligibles in New Jersey, and there are some advantages with a FIDE SNP enrollment, such as knowing that the enrollees will never receive any bills from physicians as long as they use the in-network providers. A decision on whether or not a dually eligible person would benefit from a voluntary enrollment in a FIDE SNP should be made on an individualized basis.
The Arc of New Jersey anticipates that additional information will be available in the coming weeks on voluntary enrollment in FIDE SNPs, and we will distribute the information as soon as we receive it.
If you have questions on whether enrolling in a FIDE SNP would be beneficial for a dually eligible individual, you may want to speak to a counselor at NJ’s State Health Insurance Assistance Program (SHIP). The services from SHIP counselors are always free and unbiased, and they can address questions pertaining to Medicare beneficiaries, as well as persons who have both Medicare and Medicaid, with or without private health insurance. To obtain further information, please call 1-800-792-8820 or visit the SHIP website at: http://www.nj.gov/
Again, The Arc of New Jersey wants to thank NJ DHS for its decision to remove the section on mandatory FIDE SNP enrollment from the Comprehensive Medicaid Waiver, and we thank everyone who submitted a comment to DHS on this proposal.
Join Us for The 2017 Medicare Part D Changes for Persons Who Have Both Medicare and Medicaid, Nov. 18, 2016
The 2017 Medicare Part D Changes for Persons Who Have Both Medicare and Medicaid, Nov. 18, 2016
Join us for a free webinar on Nov 18, 2016 at 10:00 AM EST.
Beginning on January 1, 2017, there will be some 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.
After registering, you will receive a confirmation email containing information about joining the webinar.
FREE Fall/Winter Health Webinar Series from the Rehabilitation Research & Training Center on Developmental Disabilities and Health
We are excited to present the next series of webinars from the Rehabilitation Research and Training Center on Developmental Disabilities and Health (RRTCDD).
RRTCDD has made significant contributions to advance research and practice across the lifespan for people with intellectual and developmental disabilities (I/DD) and their families. We hope these webinars will give attendees useful information and strategies to improve health and community participation among people with I/DD.
See the full descriptions at each link, and stay tuned for updates!
All webinars start at 2pm CT (3pm ET) and are 60 minutes long.
WEBINAR 1- September 22, 2016 - THIS SESSION HAS BEEN COMPLETED
Racial and Ethnic Disparities Among Adults with I/DD and Their Family Caregivers
Presenter: Sandy Magana
WEBINAR 2- October 20, 2016 - THIS SESSION HAS BEEN COMPLETED
Promoting Collaboration Between Hospice and Palliative Care Providers and Adult Day Services for Individuals with Intellectual and Developmental Disabilities
Presenters: Corina Ronneberg and Lisa Peters-Beumer
WEBINAR 3- January 19, 2017
Healthy Relationships and Healthy Sexuality for People with Developmental Disability
Presenter: Susan Kahan
WEBINAR 4- February 16, 2017
Aging and Dementia Care for People with Intellectual Disabilities
Presenter: Matthew Janicki
WEBINAR 5- March 16, 2017
Transition of Young Adults with Developmental Disabilities to Adult-Systems of Care
Presenter: Kruti Acharya
WEBINAR 6- April 20, 2017
Social Support Networks of Aging Persons with Intellectual Disabilities
Presenter: Lieke van Heumen
Helpful Information on NJ Medicaid:
The Arc of NJ's: Medicaid Eligibility Problem Form: (Recently Revised) 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.
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 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...
Current Healthy Times Newsletter:
In this Issue:
- Q and A on New Jersey's Proposal to Require all Dual Eligibles to Enroll in a Medicare Managed Care Plan called "FIDE SNP"
- Crisis Assessment Response and Enhanced Services (C.A.R.E.S.)
- The Special Needs Ambassador Program: A Vehicle for Advocacy, Education and Intervention
- The Arc of New Jersey's 27th Annual Conference on Medical Care for People with Intellectual & Developmental Disabilities - June 3, 2016
- The Arc of New Jersey Family Institute
- If Social Security Denies an Application for SSI, There is an Online Appeals Process
- Important Information for Anyone Receiving SSI and Planning a Vacation Outside of the United States
- Rutgers/Robert Wood Johnson Medical School- The Boggs Center on Developmental Disabilities, New Jersey Partners in Policymaking, Now Accepting Applications
Past Healthy Times Newsletters:
Kaiser Health News' consumer columnist Michelle Andrews writes: "Sepsis kills more than 250,000 people every year. People at highest risk are those with weakened immune systems, the very young and elderly, patients with chronic diseases such as diabetes, cancer or kidney disease and those with illnesses such as pneumonia or who use catheters that can cause infections. But it can strike anyone, even a healthy child like Rory." (Andrews, 8/23)
Kaiser Health News columnist Judith Graham writes: "Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way. Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic. “I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015. Her distraught husband didn’t know what to do until a long-time friend — a neurologist — insisted that Charnes return to the hospital." (Graham, 9/1)
The Arc of New Jersey's 27th Annual Conference on Medical Care for People with Intellectual & Developmental Disabilities - June 3, 2016
On June 3, The Arc of New Jersey's Mainstreaming Medical Care Program hosted its 27th Annual Conference at the Westin in Princeton. The conference is an important opportunity for attendees to learn more about providing quality health care to individuals with intellectual and developmental disabilities. Speakers included DHS Commissioner Connolly, DDD Assistant Commissioner Shea and Division of Medical Assistance and Health Services Director Davey, as well as keynote speaker Dr. Rick Rader.
Dual Diagnosis Resources
- How to cope when an adult loved one with a developmental disability experiences mental health or behavioral issues. The purpose of this handbook is to inform and empower families so that they can more effectively advocate for an adult relative with a dual diagnosis during a mental health and/or behavioral crisis.
Crises are a Family Affair
Lucille Esralew, Ph.D. Clinical Administrator SCCAT & S-COPE, Trinitas Regional Medical Center
In a mental or behavioral health crisis, we all tend to focus on one identified individual. However, I would like to suggest that this is a limited and not particularly helpful approach because crises affect all members of the family.
For the purpose of our discussion we will follow John, a hypothetical individual, age 24, who receives DDD services and who has an intellectual disability as well as a diagnosis of bipolar disorder. John's mother, Mrs. Smith, is John's primary caregiver and support person. According to our usual thinking and practice, if John has acted unsafely, resulting in his need for crisis services or hospitalization, all services leading up to, during and following hospitalization would focus on John. For the purpose of our review, all members of John's family are affected by events leading up to crisis, during crisis and in the aftermath of a mental health or behavioral emergency. Read more.
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
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.
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