As you get older, the need for affordable medical care becomes increasingly important. The same is true if you are blind or live with a disability. Luckily, New Jersey has you covered through a program called NJ FamilyCare Aged, Blind, and Disabled, also known as ABD Medicaid.
This article will introduce you to the NJ FamilyCare program and walk you through the eligibility requirements.
Medicaid for the Aged, Blind, and Disabled
NJ FamilyCare Aged, Blind, and Disabled is a program extending healthcare coverage to, as the name suggests, the elderly and those who are blind or disabled. ABD Medicaid covers a wide variety of services, including doctors visits, hospitalizations, mental health services, prescriptions, specialist visits, and more.
Often this program goes hand-in-hand with the Supplemental Security Income (SSI) program, which provides monthly payments to eligible individuals who are above 65 years old, are blind, or are disabled. If you qualify for SSI, then you are eligible to receive full ABD Medicaid benefits.
However, it is still possible to qualify for ABD Medicaid even if you do not receive SSI. We will discuss the eligibility requirements in the next section.
Qualifying for New Jersey Care for the Aged, Blind, and Disabled
When applying for ABD Medicaid, the agency considers your age, health status, insurance need, income, assets, and residence. As mentioned above, individuals who receive SSI are automatically eligible for ABD Medicaid. However, you can still qualify if you do not receive SSI benefits.
You can qualify for ABD Medicaid by satisfying either the age or health status requirement, or both. To satisfy the age requirement, you must be at least 65 years old. Alternatively, if the Social Security Administration or Department of Medical and Health Services (DMAHS) Medical Review Team determines that you are blind or disabled, you can qualify for ABD Medicaid, regardless of your age.
Often, individuals who qualify for ABD Medicaid receive Medicare benefits as their primary insurance. Luckily, you can be dual eligible for Medicare and ABD Medicaid. If you are dual eligible, Medicare will be your primary insurance while Medicaid covers Medicare premiums and other healthcare expenses.
To qualify for ABD Medicaid, you must be a United States citizen or legal permanent resident. Additionally, you must live in New Jersey and have no intention of leaving.
Qualifying as Disabled or Blind
You are considered disabled if you have an impairment that substantially limits one or more of your major life activities. Major life activities include a variety of self-help tasks, such as eating, drinking, bathing, walking, and more. To be considered disabled or blind for the purposes of ABD Medicaid, you will need to get an official determination by the Social Security Administration or DMAHS.
Determining whether you satisfy New Jersey Care for the Aged, Blind, and Disabled’s income requirements can be daunting. As a general matter, your monthly income must be at or below 100% of the federal poverty level. However, there is more nuance to the income equation.
ABD does not count $20 of unearned income, which includes Social Security Income or your pension. This program also considers in-kind support and maintenance as unearned income under certain circumstances. These circumstances are where the applicant is living in another person’s household and/or where the applicant’s food or shelter is provided by someone else (besides a spouse, parent, or minor child). In these circumstances, you are deemed to have received $260.33 (for an individual), or $380.67 (for a couple) of unearned income.
So, say you receive $700 a month in SSI and you live in another person’s household. If you are applying as an individual, you are deemed to have received $940.33 in monthly unearned income for ABD Medicaid purposes. This is calculated by adding your SSI income and the $260.33 for living in another person’s household (see above), and subtracting $20 (as explained above.). $700 + $260.33 – $20 = $940.33.
Further, ABD does not consider the first $65 of earned income and one-half of the remainder. Earned income includes wages, self-employment earnings, paid sick leave, and more. Let’s say you receive $1065 per month in earned income. For ABD Medicaid purposes, you receive $500 per month in earned income. First, subtract $65 from the total monthly income, and then divide the remainder in half. $1065 – $65 = $1000; $1000/2 = $500.
Assets are items of value that can be converted into cash. Assets can include available cash, bank accounts, mortgages, automobiles, and more. Working with an attorney can help you to inventory and value your assets.
To qualify for ABD, you can not have more than $4000 worth of assets if you are single, or $6000 as a couple. However, unlike other Medicaid programs, ABD does not impose a look-back period or transfer penalty unless you are seeking to reside in a long-term care facility or to apply for Home- and Community-Based Waiver services.
If you are elderly, blind, or disabled, you should know that you have options for affordable healthcare. NJ FamilyCare’s Aged, Blind, and Disabled program helps you access the essential medical services that you need for a long and healthy life.
At The Chamberlain Law Firm, we are here to educate the public about the various Medicaid programs the Garden State has to offer. We also help with estate planning, probate matters, and planning for long-term care. Give us a call at (201) 273-9763 today to set up a consultation. Also, be sure to check out our blog for more Medicaid insights.