Eligibility Requirements
In order to be eligible to receive services from the Division of Developmental Disabilities (“DDD”) an individual must be domiciled in the State of New Jersey, must be over the age of 21 years, must have been discharged from their school system after completing their educational entitlement, and must have a developmental disability. A developmental disability means a severe, chronic disability of an individual which:
- Is attributable to a mental or physical impairment or combination of mental or physical impairments.
- Is manifest (meaning the impairment is detected) before age 22.
- Is likely to continue indefinitely.
- Results in substantial functional limitations in three (3) or more of the following areas of major activities of daily living:
- Self-care;
- Receptive and expressive language (the understanding and use of);
- Learning;
- Mobility;
- Self-direction;
- Capacity for independent living; and
- Economic self-sufficiency.
If an individual meets all three (3) of these, the individual is eligible to begin the process of accessing services from the Division of Developmental Disabilities. Once an individual has applied for services from the Division of Developmental Disabilities the Division will evaluate eligibility.
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Qualifying for DDD Services
In order to be eligible for DDD services, a person needs to be eligible for Medicaid services (not Medicare). That means meeting the income and medical eligibility criteria under NJ Medicaid law. I discuss Medicaid eligibility on our Medicaid Eligibility and Planning Strategies to Protect Asset and Income page (click here).
The next step in the process is the completion of the New Jersey Comprehensive Assessment Tool” or “NJCAT”. The New Jersey Comprehensive Assessment Tool is what the State of New Jersey uses to determine how large of a budget to devote to each person who has a disability. Here in New Jersey, services provided by DDD are largely self-directed, meaning that a person with a disability and their family members are able to self-direct and self-select eligible services based on the person’s budget. That’s what “self-directed” means. For example, if an individual with a disability has a $25,000.00 budget, some of that budget can be devoted to things like transportation, additional education, socialization opportunities, activities, personal aid assistance, and enrichment activities. An example of an enrichment activity would be joining a bowling league, and fees to participate in a photography class at a local community college.
DDD and Medicaid
As previously stated, in order to access services from the DDD an individual must be eligible for Medicaid. In order to be eligible for Medicaid the individual typically needs to have less than $2,000.00 in available resources and generate less than approximately $1,170.00 per month in earned income. The unearned income threshold is lower. It is approximately $802.25 per month. If a family member or a person has more earned income or unearned income than allowed by Medicaid, there may be other alternative methods for achieving Medicaid eligibility for that person. In such a case, we can also help you. Please call Fredrick P. Niemann, Esq. at Hanlon Niemann & Wright, P.C. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com. to meet and discuss available options for your family member.
Accessing Residential Housing Now or in the Future
In order to obtain housing from DDD, a person must be eligible for Medicaid as well as DDD services. The process for qualifying begins by applying for DDD services and being placed on a waiting list for residential placement. When applying for housing, it is important to understand that not every individual with a developmental disability will receive housing. Housing assistance is based on several factors.
Typically, to be eligible for housing the individual must have a Tier Assignment of C or greater, or they must have “acuity” along with their disability If you are not sure what your family member’s tier assignment is, you can request that information from the Division of Developmental Disability.
Tier Assignment A typically means a person needs the least amount of physical assistance or verbal prompting with their activities of daily living. Tier Assignment B indicates a person needs a bit more assistance while Tier Assignment C indicates that a person is incapable of living independently. Tier C persons typically require something like a group home or a supervised apartment but sometimes more supervision is required. A Tier Assignment D or greater will almost always require an intensively supportive group home or institutionalization. What does this mean in layman’s terms? Well, it all comes down to your budget. When you have an individual with a developmental disability, they are entitled to a specific budget for DDD services. Once they are at the point in life where they are eligible to receive housing, they are given a separate housing budget. For example, they may have a residential placement through ARC but their day program(s) might be run by Easter Seals. Typically, they are not run by the same agency, although it can happen. When evaluating what is appropriate for your family member, the first thing to think about is what they can and cannot do if there was/is no family or individual assisting them. If your loved one were to wake up (say) on a Monday morning and no one was present with him or her, would they communicate with anyone, would they make themself something for breakfast, would they take a shower, would they get dressed, would they contemplate their day’s activities or plan something for lunch and/or dinner, would they take their medication(s)? If the answer to any of these questions is “no” or “I am not sure”, they are probably not a candidate to live independently. If they require anything more than verbal prompting to engage in activities of daily living, they are probably going to need some form of residential placement in the future. So how do you get access to residential placements? It all starts by being placed on the waiting list. Under certain circumstances, it may be possible to get an emergency placement. Contact Fredrick P. Niemann, Esq. to discuss an emergency placement toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.
When an individual goes into a residential placement, it is supposed to be in the least restrictive environment suitable for their need(s). That means that somebody who is reading and writing and thinking at a fifth-grade level should not be living with a group of people who are non-verbal. They should be living in the least restrictive community setting where they can advocate for themselves and make the choices that they are capable of making. To the extent that they are capable of expressing themselves, their wishes should be taken into consideration when making a decision for housing.
Waiting List for a Residential Placement for a DDD Eligible Person; How Does It Work?
After an evaluation, the next thing that will happen is… you’ll wait. A family will periodically receive a letter disclosing where a person is on the waiting list. Each year approximately 200 to 300 individuals move off the priority category into a residential placement. Typically, individuals who are waiting in what’s called “the general category” are waiting there for one of the following reasons: a) because the parents have not yet attained the age of 55 or b) they are not yet eligible for housing for another reason. You will not receive a residential placement for your child if you are in the general category in the absence of an emergency. Typically, it takes approximately 10 to 15 years to move to the top of the “priority” waiting list and to receive a residential placement from DDD. When your loved one’s number comes up, you are not forced to move your loved one into the first available placement. Instead, you and your family will get to go visit the residential placements that are available and appropriate, and then you will get to select the one that you feel is the most appropriate, assuming there is availability. This process takes some time. Once a loved one has moved into a residential placement, they and their family always have the right to re-visit whether or not the placement is appropriate. This is important. If your family member moves into a group home and you no longer think that the group home is appropriate it is possible to contact your support coordinator from the DDD and seek an alternative residential placement.
DDD Troubleshooting and Loss of DDD Eligibility
Sometimes, no matter what, something goes wrong in the process and a person loses eligibility for DDD services. For example, funding is cut, their Tier Assignment is changed, or they lose access to their day program or their group home.
It is important to understand that there is a process to restore services, especially if a responsible person has failed to timely resubmit the paperwork required by DDD to continue services or SSI or Medicaid has been lost.
In order to restore DDD eligibility, action should be taken immediately. Hanlon Niemann & Wright can help you with the support coordination or advocate through the DDD Medicaid help desk and include the support coordinator in the process. The goal is to avoid being classified as “inactive” by DDD and disrupting Medicaid funding which will then interrupt DDD funding now or at some point later in their life.
Can an Interruption in DDD Funding Happen?
The answer is yes. You may then ask; how does this happen? Most often an interruption to DDD funding happens because a parent either retires or passes, in which case, the dependent adult child will stop receiving SSI and will receive instead SSD or SSA because these benefits are based on the parent’s work record and how much he or she paid into the system. The dependent child’s monthly income increases. This can have negative consequences because if the child is collecting too much social security income, they will be over the unearned income limit for Medicaid beneficiaries. This means that they can lose eligibility, including Medicaid benefits. Remember, a person needs to remain eligible for Medicaid in order to continue to receive services from the DDD. The State of New Jersey recognizes that this is an ongoing problem. Unfortunately, even though the State recognizes this is a problem, a solution is often not easy or quick. It is not uncommon for individuals under DDD who collects social security benefits based on their parent’s work history to lose their Medicaid and go through the process of reapplying for Medicaid with the State. It is equally common for an individual to need to reapply for Medicaid through the State when a parent dies.
So then what happens? How can you solve this? Let Hanlon Niemann & Wright guide you through the reinstatement process including New Jersey Family Care. You can contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com
When filing an application for Medicaid the County will not be familiar with your child. He or she will be a brand-new applicant to the County. You must give the County a lot of information about your child, including five years of bank statements for every bank account that the child owns and any Trust in which your child is the beneficiary. You will need to give them a copy of the Trust documents. If you skip any of these steps, it will be much more difficult to regain Medicaid benefits. It is really important to remember not to get upset with the providers if there is an interruption in access to services. If your child has lost their Medicaid and as a result, they have lost their eligibility for DDD services, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 to begin the process of attempting to restore these benefits.
My Child Lost Their Medicaid – Now What?
If your child has lost their Medicaid as stated in the previous section most of the time it is because they have either too much earned income or too much unearned income.
A Disabled Adult Child as defined under the Social Security Act at section 1634 (also referred to as a “1634 DAC”) is a person who (i) was receiving SSI benefits; (ii) is at least age eighteen; (iii) has blindness or a disability which began before age twenty-two; (iv) received SSI benefits based on blindness or disability; and (v) lost SSI because he or she became eligible for SSDI benefits on a parent’s record due to the retirement, death or disability of a parent. These 1634 DACs will continue to be eligible for Medicaid in New Jersey as long as the DAC is still blind or disabled and continues to have no more than $2,000 of countable assets. The most common reason is too much unearned income in either social security benefits or an inheritance from a parent in the form of a pension or an annuity. It is also possible that a child may have lost their Medicaid eligibility because he or she owns too much in available property and resources. Most Medicaid programs will require your child to have less than $2,000.00 in available resources. Available resources are all the money in their bank accounts, any CDs, any savings bonds and any cash they might have on hand. If grandma and grandpa buy a grandchild stock, they count as available resources too. If your child has more than $2,000.00 in available resources in any month, they will not be eligible for Medicaid services. One possible solution is to fund something called an “Able Account”, a tax-deferred savings account that does not count as an available resource under certain circumstances. However, there are limitations on how much money can be contributed to an Able Account each year. The current limitation is $15,000.00. It is indexed annually. If your child has more than $15,000.00 to his or her name, a Special Needs Trust might be a good option. Your child must be under the age of 65 for an attorney to create a Special Needs Trust and place the funds inside of it. If you would like to discuss an ABL Account or a Special Needs Trust with our firm please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fneimann@hnlawfirm.com. Remember Medicaid benefits can almost always be restored it just takes time.
My Application for SSI or Medicaid was Denied – Now What Do I Do?
If you filed an application for SSI or Medicaid on behalf of your loved one and that application was denied, the next step is to file for a Fair Hearing Appeal. Attached to the Notice of Denial from the County will be a letter that gives you the right to ask for a Fair Hearing. You must complete this letter, sign it and send it to the Fair Hearing Department within twenty (20) days of the date of the letter. Sometimes (most times) the mail is a bit slow and the letters are dated as much as ten (10) to twelve (12) days before the date you actually receive it. It is really important you look at the date of the letter at the top in the right-hand corner. That is the date that will be important for determining what your deadline is to file a Fair Hearing appeal. If you are going to appeal the denial of Medicaid benefits and you would like assistance with this, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fneimann@hnlawfirm.com. Our offices are conveniently located off Route 9 in Freehold, NJ.
Fredrick P. Niemann Esq.