Disability-Based Medicaid

Is It Right for You?

Medicaid, also called NJ FamilyCare, is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Medicaid.
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Medicaid coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability. Disability-based Medicaid is explained on this page.
• Have a disability and work, even if your income is higher. Learn more about Medicaid's NJ WorkAbility program.

Answer the questions on this page to see if you might qualify for disability-based Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on GetCoveredNJ.

Medicaid’s rules for immigrants:

• Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
• Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

Do You Have a Disability That Meets Social Security’s Standards?

To qualify for disability-based Medicaid, you must have a disability that meets Social Security’s definition of disability. For adults, Social Security says you have a disability if:

• You have a physical or mental impairment or combination of impairments
• Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,550 per month or $2,590 per month if you’re blind), and
• Your condition has lasted or is expected to last for at least 12 months.

If you currently get disability benefits, like Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards. If not, New Jersey's Disability Determination Service (DDS) checks to see if your disability qualifies for Medicaid.

Note: Learn about Social Security’s definition of disability for children under 18 in DB101’s Benefits for Young People article.

If you already have a disability determination from Social Security or think that your disability meets Social Security’s standards, disability-based Medicaid might cover you.

Do You Have Very Low Resources?

Resources are money and property you own. For disability-based Medicaid, you and your family must have very low resources:

• If you are single, the most you can have is $4,000 in resources.
• For couples, the limit is $6,000.

Some resources don’t count towards disability-based Medicaid’s resource limit, like the home you live in, one car, and any money you have in an ABLE account.

If your family’s resources are below the limit, disability-based Medicaid might cover you.

Do You Have Very Low Income?

To qualify for disability-based Medicaid, you must have countable income that is $1,255 per month or less ($1,704 or less for couples).

For disability-based Medicaid eligibility, not all of your income is counted. The way your income is counted for disability-based Medicaid is very similar to SSI’s countable income calculation:

• Most of your unearned income is counted.
  • Important: SSI and NJ SNAP benefits are not counted for disability-based Medicaid eligibility.
• Less than half of your earned income is counted.

This means that if you have a disability determination, you might be able to get a job and make $1,900 per month or more without losing your disability-based Medicaid, because more than half of your earned income wouldn’t be counted.

If you live alone, try this tool to see if your countable income is below disability-based Medicaid’s income limit.

If you live with others, some of their income may be counted and you should call a Health Benefits Coordinator at 1-800-701-0710 or 1-800-701-0720 (TTY) or visit an outreach and enrollment site in your county to talk about whether you qualify for Medicaid coverage.

If your income is low enough and you meet all other requirements, you should sign up for Medicaid.

More Ways to Qualify for Medicaid if You Have a Disability

There are other ways to qualify for Medicaid if you have a disability. You might qualify for income-based Medicaid if:

• Your disability does not meet Social Security’s definition of disability. Disability-based Medicaid is only for people who have disabilities meeting this standard.
• You have more resources than are allowed by disability-based Medicaid.
• You make enough money that you would have to pay a monthly premium for NJ WorkAbility.

You might qualify for disability-based Medicaid instead of income-based Medicaid if:

• You make more money at work than income-based Medicaid allows. In that case, you could apply for Medicaid's New Jersey WorkAbility program.
• You also get Medicare. Income-based Medicaid doesn’t cover people getting Medicare, but disability-based Medicaid does. It may even help pay your monthly Medicare premiums.
• You are 65 years old or older.

Learn more about income-based Medicaid and NJ WorkAbility.

How to Sign Up

Before you apply, NJHelps lets you check if you might qualify for Medicaid or other state and federal programs.

You can apply for Medicaid:

• Online using NJ FamilyCare Quickstart, or
• At an outreach and enrollment site in your county.

NJ FamilyCare lists the information and documents you may need when you apply. For help with your application, talk with a Health Benefits Coordinator at 1-800-701-0710 or 1-800-701-0720 (TTY).

Staying on Medicaid

Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county Board of Social Services know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Medicaid or if you have new health coverage options, like individual coverage with subsidies or NJ WorkAbility.