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Health Care Advocacy

Problem Forms

  • Family members and staff may use this form when a person with IDD is having difficulty obtaining Medicaid.

  • Family members and staff may use this form if an individual is currently enrolled in a Medicaid MCO/HMO and is having difficulty obtaining a medical, dental, or behavioral health service that should be covered. This form can also be used if the MCO/HMO has reduced the approved number of hours of a service (e.g., personal care assistance or private duty nursing).


Are you someone who needs help navigating the system? Do you need help with Medicaid, Medicare, Social Security, or another healthcare-related issue? The Arc of New Jersey is here to help with questions and concerns.

Please include as much information as possible when filling out the form below. After you submit the form, a member of the Health Care Advocacy staff will contact you as soon as possible. 

Individual Information

Month
/
Day
/
Year

Social Security

Is the individual currently receiving Supplemental Security Income (SSI)?
Is the individual currently receiving Social Security Disability Insurance (SSDI)? (or a Survivor's Benefit, if a parent has passed away)
Is the individual receiving Social Security benefits based upon a parent's work record?

Health Insurance

Is the individual receiving NJ FamilyCare/Medicaid?
Is the individual receiving Medicare?
Does the individual have private health insurance?

Contact Information

Is another organization, agency, or individual assisting you on this matter?

What Are You Having Difficulty With?

Please check each box that best fits your problem:

Referral Information

Would you like to receive email updates from The Arc of New Jersey Health Care Advocacy program?
I give permission for this information to be forwarded by The Arc of New Jersey to the Department of Children and Families (DCF), the Division of Developmental Disabilities (DDD), NJ Division of Medical Assistance and Health Services (NJ FamilyCare/Medicaid), or any other agency that may be able to help.
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