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Health Care Advocacy

Problem Forms

  • Family members and staff may use this form when a person with an intellectual and developmental disability is having difficulty obtaining Medicaid.

  • 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 if the HMO has reduced the approved number of hours of a service (e.g., personal care assistant services or private duty nursing).


Are you a caregiver, individual, or professional who needs help navigating the system? Are you facing difficulties with Social Security, Medicaid, or other health care issues? No matter how old your child or loved one is, The Arc of New Jersey is here to help with questions or concerns.

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

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 the 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) and/or NJ Division of Medical Assistance and Health Services (NJ Medicaid), or any other agency that may be able to help.
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