What You Need to Understand Medicaid
"All people, including people with intellectual and/or developmental disabilities (IDD), should have timely access to high quality, comprehensive, accessible, affordable, appropriate health care that meets their individual needs, maximizes health, well-being and function, and increases independence and community participation."
To read more of The Arc’s Position Statement on Health Care, click here.
Medicaid
Provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
NJ FamilyCare is New Jersey's Medicaid program that provides public health care coverage throughout the state.
There are two primary programs:
- NJ FamilyCare, covering children under 19, adults, and pregnant women.
- NJ FamilyCare Aged, Blind, Disabled (ABD) Programs, covering people 65 and older, and people determined blind or disabled by the Social Security Administration (SSA) or State of NJ. The majority of people with IDD receive Medicaid through SSI or the ABD programs.
NJ FamilyCare ABD Programs include:
- Supplemental Security Income (SSI) Medicaid
- Medicaid Only
- New Jersey Care... Special Medicaid Programs
- NJ WorkAbility
- Managed Long Term Services and Supports (MLTSS)
Some individuals with IDD who receive SSI and Medicaid subsequently lose both upon the retirement, disability, or death of a parent. This occurs because the individual with IDD starts receiving a Social Security benefit, or Survivor's benefit, based on the parent's work record, causing the individual with IDD to lose SSI. But the individual can remain qualified for Medicaid as a Disabled Adult Child (DAC) under Section 1634 of the Social Security Act.
Other individuals with IDD may not have been on SSI or Medicaid before they began receiving Social Security benefits due to the retirement, disability, or death of a parent, which often prevents them from financially qualifying for SSI. Individuals with IDD making less than 100% of the Federal Poverty Level (FPL) or $1,330/month (2026) can apply for NJ Care Special Medicaid through their County Social Service Agency. If the individual is making more than 138% of the FPL or $1,836/month (2026), they can apply for special status through DDD whereby the individual completes a DDD intake application and, upon approval for services, receives a Medicaid application through the DDD waiver unit within 90 days of age 21 (or when first eligible for DDD servces).
Certain individuals with IDD become eligible to receive Medicare, in addition to Medicaid, prior to age 65. These individuals are referred to as "Dual Eligibles." This scenario often occurs when an individual with IDD receives a Social Security benefit from a parent's work record for at least 24 months, after which the individual automatically qualifies for Medicare coverage.
Medicaid is a requirement to receive services from the New Jersey Division of Developmental Disabilities (DDD), which usually become available once an individual with IDD turns 21. For more information, visit the DDD website.
DDD administers two Medicaid waiver programs, the Supports Program (SP) and Community Care Program (CCP). These programs are intended to provide individuals with home and community based supports, based on their personal needs and budget.
Federal Changes to NJ FamilyCare/Medicaid
The federal government has changed the rules around who is eligible for NJ FamilyCare starting Fall 2026. These rule changes are part of the “One Big Beautiful Bill Act” that was signed into law by President Trump in July 2025. These new rules do not apply to everyone. You can find more information that explains which members may be affected and how they can prepare.
Qualifying for Medicaid
Many adults with IDD (age 18+) automatically qualify for Medicaid if they are approved for Social Security Supplemental Security Income (SSI) benefits.
If a person does not apply or cannot qualify for SSI, they must apply for Medicaid through NJ FamilyCare. A person can apply for Medicaid online through the NJ FamilyCare website.
Individuals with IDD are strongly encouraged to apply for ABD Medicaid. This can be done through an online application or you can print the paper ABD application and submit the completed application, along with supporting documentation, to your County Social Services Agency.
Health Care Advocacy
The Arc of New Jersey's Health Care Advocacy Program promotes quality health care for people with intellectual and developmental disabilities throughout New Jersey.
If you are having difficulties with Medicaid, submit a problem form.The program also offers numerous other resources related to Medicaid.
Medical Assistance Customer Centers (MACCs)
Available to provide customer service to NJ FamilyCare members and the public. Contact your local MACC office.
More Information
Medicaid/NJ FamilyCare
- NJ FamilyCare/Medicaid
- ABD Medicaid Programs
- Medicaid for Individuals with IDD in NJ
- Different Types of NJ Medicaid Fact Sheet
- NJ WorkAbility Medicaid Fact Sheet
- NJ Division of Medical Assistance and Health Services
- NJ Medicaid Managed Care Organizations
- The Arc of NJ Health Care Advocacy Medicaid Resources
- Private Health Insurance for an Adult Child with IDD Beyond Age 26
- NJ FamilyCare Personal Care Assistant (PCA) Services
- NJ FamilyCare Personal Preference Program (PPP)
- Medicaid Fair Hearing Fact Sheet
Medicaid and Medicare
- Medicaid vs Medicare Fact Sheet
- Dual Eligibles FAQs
- Dual Eligibles & Prescription Medication FAQs
- Dual Eligibles & Special Needs Plans (D-SNPs) FAQs
