Sta
te of New
Jersey
Jon S. C
orzine, Governor
Dep
artm
ent of H
um
an
Services
Clarke B
runo, Acting C
omm
issioner
NEW JERSEYDEPARTMENT OF HUMAN SERVICES, DIVISION OF DISABILITY SERVICES
NJ
WorkA
bilityF
requentlyA
skedQ
uestions(F
AQ
s)
Th
is publication
is fun
ded by G
rant #11P
-93058-2/02T
he C
enters for M
edicare and M
edicaidS
ervices (CM
S)
ww
w.n
jworkability.n
j.gov
If you or you
r agency w
ould like
additional in
formation
,please call:
1-888-285-3036 (option
2)F
or assistance w
ithben
efits plann
ing services,
please call:1-877-659-4672
Q:
What is N
J WorkA
bility (NJW
)?A
:N
J WorkA
bility is a state and federally funded program
that provides Medicaid
health benefits, at a higher income
eligibility level than ever before , to people w
ith disabilities who are w
orking.
Q:
Who is eligible for N
J WorkA
bility?A
.A person m
ust be between the ages of 16
and 64, employed full or part tim
e, and have a perm
anent physical or mental
disability.
Q:
Will I qualify if I am
self-employed?
A:
Yes, self-employed individuals w
ith disabilities are also covered; you just need to provide docum
entation of self-em
ployment and incom
e.
Q:
What does N
J WorkA
bility cover?A
:N
J WorkA
bility covers all the medical and
healthcare services available through M
edicaid. These may include, but are not
limited to, durable m
edical equipment,
outpatient counseling, m
edical transportation, dental and vision care, personal care services, pharm
aceuticals and other m
edical services.
Q:
How
does WorkA
bility apply to a seasonal em
ployee?A
:W
hen the employee is not w
orking, he/she is ineligible for any m
onth where
there is no employm
ent (unless receiving paid sick leave, tem
porary disability paym
ents or workers’ com
pensation). If theperson does not report stopping w
ork as required, and continues to receive benefits during that period, that individual w
ill have incorrectly received benefits w
hich w
ill be subject to recovery.
Q:
If an SSI beneficiary works and exhausts
all SSI work deductions (ending their cash
benefits), do they have to accept and then exceed 1619B
benefits before going on the W
orkAbility program
?A
: If a person is still actively receiving SSI, w
e recom
mend they utilize the SSI 1619B
program
. If an applicant’s SSI eligibility is already term
inated, we do not require them
return to SSA; how
ever, we do ask for their
letter of termination to clarify that
termination w
as due to earnings or work
activity (as opposed to termination because
of no longer being medically disabled). W
e accept the SSA disability determ
ination rather than com
pleting another determina-
tion through the DM
AH
S Disability R
eviewteam
. If SSA says you are no longer dis-abled, w
e have to abide by that decision forone year before the person can re-apply.
16
Q:
How
much can you earn and still be
covered by NJ W
orkAbility?
A:
You can earn as much as $49,020 (gross)
annually and still be fully eligible for M
edicaid coverage through NJ W
orkAbility.
Q:
Do you have to be receiving benefits, such
as Social Security Disability Incom
e (SSDI)
or Supplemental Security Incom
e (SSI)?A
:N
o, as long as you are working and have a
permanent disability (w
hich can be determ
ined by the County B
oard of Social Services &
the Division of M
edical A
ssistance & H
ealth Services Disability
Review
Team).
Q:
What happens if the Social Security
Adm
inistration (SSA) determ
ined I am
not disabled?A
: Your application can be review
ed to see if that decision can be appealed, or if you w
ould be subject to the one year re-application rule.
Q:
Does w
orking mean I am
automatically
considered not to be disabled?A
:N
o, for this program your disability status
is evaluated without consideration of your
work activity. You are assessed as an
individual who is w
orking despite a perm
anent disability.
Q:
What is the application process for
felons/ people with crim
inal records?A
: The application process w
ould include adisability determ
ination that the County
Board of Social Services (C
BSS) w
ouldrequest through the state using recordsand form
s from the correctional facility.
Additionally, if the facility has subm
ittedan application through the Social SecurityA
dministration (SSA
) then the County/
State cannot process a concurrent disabilitydeterm
ination. If there has been a SSAdisability denial, the state is bound tohonor that decision for one year.
Q:
Is Unem
ployment Insurance considered
earned or unearned income?
A:
Unem
ployment insurance benefits are
considered unearned income.
Q:
If I am under 18 years of age, w
orking parttim
e and living with parents or fam
ily, is m
y family’s incom
e considered? A
:E
ligibility will be determ
ined by theC
ounty of Board Social
Services. A parent’sincom
e would be
deemed to the applicant
for those under age 18.The deem
ed amount is
treated as countableunearned incom
e.
52
Q:
If my spouse is not disabled, w
ould their incom
e be counted for my eligibility?
A:
Yes, the income of an ineligible spouse is
evaluated by the process of “deeming” a
portion of the income to the spouse
applying for eligibility. It is counted as unearned incom
e.
Q:
Where do I apply?
A:
If you are interested in applying, call toll free 1-888-285-3036, option 2 for initial screening and inform
ation. Applications
are taken and eligibility determination is
made at your C
ounty Board of Social
Services (CB
SS).
Q:
How
do I find out what services are
covered? How
do I find doctors/providersthat participate?
A:
Contact the M
edical Assistance C
ustomer
Center (M
AC
C) to find services/doctors/
providers. To locate the MA
CC
in yourarea call, 1-800-356-1561. If you areenrolled in a m
edicaid managed care
program, you w
ould contact that HM
O.
Q:
What happens w
hen I’m not w
orking?A
:This needs to be reported to your C
BSS to
determine if your status perm
its continua-tion of benefits, or if your eligibility needsto be suspended to avoid possible repay-m
ent of incorrectly paid benefits.
Q:
Can I use m
y employer health
insurance?A
: Yes, benefits w
ill be coordinated, with
Medicaid being the final or last payer.
Q:
Will the N
JW benefits cover m
y entire fam
ily?A
: N
o, only the eligible individual or eligible couple.
Q:
Can som
eone on WorkA
bility choose a M
edicaid HM
O or m
ust they be on fee-for-service?
A:
NJ W
orkAbility clients m
ay receive fee-for-service or
enroll in one of the M
edicaid HM
Os. In fact, w
e have been encouraging W
orkAbility clients to use
HM
O services to assure greater access to
care. Rem
ember, N
J WorkA
bility is just another route to M
edicaid eligibility - it is not a special program
.
Q:
Is there a rule regarding eligibility for felons or people w
ho have been convicted of a crim
e?A
: Prisoners m
ust no longer be under thejurisdiction of the correctional facility andm
eet all other eligibility requirements of
assistance programs. M
any correctionalinstitutions already w
ork with C
ountyB
oards of Social Service for transitionalscreening and/or applications for program
sthat can be effective upon release.
34
