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Medicaid Programs
Available Through The
SOMERSET COUNTY BOARD OF SOCIAL SERVICES
Information On:
Present Programs How to Apply
What Is Medicaid?
Medicaid is a State and Federal medical assistance program that pays medical
bills for eligible, needy persons. All payments are made directly to the
providers of medical and other health care services. The Medicaid-eligible
person does not pay the health care provider for services. The only exception is
a patient in a Medicaid approved nursing home who may be required to contribute
part of his or her income toward the cost of care.
Managed Care – All Medicaid recipients who are not elderly or disabled
will be asked to choose a managed care provider. Those who have no preference
will be assigned. The managed care providers in Somerset County are: Americhoice
of NJ, Amerigroup of NJ, Health Net, Horizon Mercy, and University Health Plan.
All recipients medical needs will be met through the managed care provider.
What Services Does Medicaid Cover?
Medicaid pays for:
- physician services in the office, clinic or other medical facility;
- a special program for children, known as Early Periodic Screening,
Diagnosis and Treatment or EPSDT;
- prescribed drugs from a pharmacy;
- hospital, inpatient and outpatient care;
- home health care, nursing home care, and medical day care as planned by
your doctor;
- clinic services including family planning and rehabilitation services,
such as physical, speech language, or occupational therapy as prescribed by
your doctor;
- mental health services in a doctor’s office or approved mental health
clinic;
- X-ray and laboratory service;
- ambulance and invalid coach service as prescribed by your doctor;
- medical supplies and equipment;
transportation to and from Medicaid approved health care services when it is
not otherwise available;
- personal care assistant services.
WHAT MEDICAID PROGRAMS ARE AVAILABLE THROUGH THE SOMERSET COUNTY BOARD OF
SOCIAL SERVICES?
TANF Related Medicaid – Most recipients of a TANF money grant are eligible to
receive Medicaid. Persons who are eligible for a TANF grant may elect to
receive Medicaid only. Persons who are no longer eligible for a money grant
due to the receipt of earned income, unemployment or state disability payments
or child support may receive extended Medicaid benefits for an additional 4-24
months.
Medicaid Special – Children up to age 21 – all children under the age of 21
may be eligible for Medicaid benefits depending upon their living
arrangements, income and resources.
New Jersey Care for Pregnant Women and Children – Pregnant women may receive
Medicaid benefits until 60 days after the end of their pregnancy. The newborn
is covered for the first year. Children born after 9/30/83 may also be covered
under this program. The income level is set by the current Federal Poverty
Level. There are no resource limitations for this program.
NJ KidCare – Children whose family income is under 350% of the poverty level
and who have not reached age 19 can be covered under this program.
PROGRAMS FOR THE ELDERLY AND DISABLED
Medicaid in the Community – Individuals who are disabled or over 65 who have
lost their SSI eligibility due to Social Security payment increases may be
eligible to receive Medicaid benefits in the community. Also eligible are
persons who would otherwise be entitled to an SSI money payment but who do not
wish to apply.
New Jersey Care for Elderly and Disabled – Elderly and disabled persons whose
income is below the present Federal Poverty Level may be eligible for the
total Medicaid coverage under this program, depending upon the amount of their
resources and their living arrangement.
Nursing Home Program – Persons in need of long term care in a nursing home may
be eligible for Medicaid depending upon their income and resources. However,
income limits for this program are considerably higher than those for Medicaid
in the community. Eligible persons may have to contribute their monthly income
(less a personal needs allowance) toward the payment of the nursing home
costs.
NJ Workability – Individuals with permanent disabilities who are between age
16 and 65 and are working may be eligible for Medicaid under this program.
Earnings may be as high as 250% of the Federal Poverty Limit (over $45,000 per
year) and countable assets may be up to $20,000. A person’s own Social
Security benefit is disregarded, but any other unearned income may not exceed
the Federal Poverty Limit.
Model Waiver Programs – A limited number of disabled adults and children may
be eligible for skilled medical care in their homes under various waiver
programs Selection of those considered medically eligible is made by the state
office of Home Care Programs. Financial eligibility is similar to that for the
Nursing Home Program and is determined by the Somerset County Board of Social
Services.
ACCAP – The purpose of this program is to allow AIDS patients in the terminal
state of illness to receive treatment and care at home. Financial eligibility
and resource requirements are similar to those of the nursing home program.
LIMITED BENEFIT PROGRAMS
Medically Needy Program - This program provides limited coverage to persons
who are disabled or over 65, pregnant women, and children under 21. This
program does not pay for inpatient hospital costs except for pregnant women.
It does not pay for prescription costs for the elderly and disabled. The
income limit for pregnant women and children is higher than that for TANF. The
income limit for the elderly and disabled is less than that for SSI. The
resource limits are comparatively high. Persons who have large out of pocket
medical expenses who are ineligible for any other Medicaid program may apply
for this one as there is a spend down provision in addition to the income
limitation.
CCPED Program – This is a program for nursing home eligible persons who wish
to receive needed services at home. However, it does not pay for doctor bills
or hospital costs. The income and resource limits are similar to those for the
nursing home program.
WHAT IF I HAVE MEDICARE?
If you are 65 or over or disabled, you could be eligible for both Medicaid and
Medicare. As a supplement to Medicare, Medicaid will pay for certain services
and items not covered by Medicare, and also provides necessary medical care
when your Medicare benefits are exhausted. Medicaid will also pay the Part B
medical premium. You must use your Medicare benefits first before Medicaid
will pay for your health care services.
WHAT IF I HAVE OTHER HEALTH INSURANCE?
If you have other health insurance, you must give this information when you
apply for assistance. Federal and State laws require all other sources of
payment for medical care to be used before Medicaid will pay a bill. Some
examples of other sources are: Blue Cross, Worker’s Compensation, and third
party insurance benefits resulting from an automobile accident or other
injury. As a condition of eligibility for Medicaid benefits, a person must
permit the Medicaid Program to use these sources of payment before Medicaid
will pay for medical or health care services.
WILL I HAVE A MEDICAID CARD?
Yes, as long as you are eligible (and not a resident of a nursing home) you
will receive a new Medicaid/Eligibility Identification Card every month. Your
eligibility period will be shown on your Medicaid ID Card.
Be sure to carry your Medicaid card with you and present it whenever you
receive a Medicaid service.
HOW DOES THE PROGRAM WORK?
Those persons in Managed Care and HMO’s will go to the primary doctor assigned
to them. This doctor will make referrals as needed. Other participants may go
to any participating doctor or provider for treatment or service. If you do
not know where to go for health service, call the Medical Assistance Customer
Center at 973-631-6440 for the name of providers in your area.
WHO MAY BE ELIGIBLE FOR MEDICAID?
Certain groups of persons whose income may make them eligible for one of the
available programs include the following:
- Individuals under 21
- Pregnant women
- The aged (65 or older), the blind, and the disabled
- Individuals in a Medicaid approved facility such as a nursing home or hospital
All persons receiving a TANF or SSI money payment may be eligible to receive
Medicaid without making separate application.
HOW DO I APPLY FOR MEDICAID IN SOMERSET COUNTY?
Persons may apply for most Medicaid Programs at any one of the three offices
of the Somerset County Board of Social Services. They are located at:
73 East High Street
Somerville NJ 08876
(908) 526-8800
610 Franklin Blvd.
Somerset NJ 08873
(732) 846-6499
391-D Somerset Street
North Plainfield NJ 07060
(908) 561-9400
Persons wishing to apply for Adult Related Medicaid Programs may apply at the
Somerville office. It is best to call for an appointment. If a person is too
ill or disabled to come for an office visit, a home visit will be arranged or
an authorized representative may be able to apply on the applicant’s behalf.
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