Public and Private Benefits: Access to Health Care

The AIDS Law Project’s Access to Healthcare is an exceptionally effective program that makes a real difference in the lives of people with HIV/AIDS. Fully 27 percent of the clients who come to the AIDS Law Project are looking for some form of public or private health insurance as the road to health care because with treatment this disease — once a short-term death sentence — can be treated as another chronic, manageable condition. The key is access to health care and medications. Through this program, uninsured people with HIV/AIDS enroll in Medicaid, Medicare, Social Security disability benefits and private insurance.  Accessing health care makes a real difference not just in the lives of clients who continue working and raising their children but also in the impact of the disease on the larger community. People with HIV/AIDS whose conditions are stabilized through health care contribute more than they cost society.

PUBLIC BENEFITS:

Cash Assistance:

WorkFirst New Jersey (WFNJ): A cash benefit program for low-income New Jerseyans. The program has two categories of eligibility: general assistance (GA), designed to help single adults, and temporary assistance for needy families (TANF), designed to help working parents. Recipients eligible for GA-related benefits must work or have work-related activity 30 hours per week. TANF eligible recipients must work or have work-related activity for 35 hours.

Recipients may receive these benefits for a lifetime limit of 60 months, unless an exemption is granted. Exemptions may be granted for individuals who are permanent disabled, sole caretaker of a disabled person, victims of family/domestic violence, the chronically unemployable, or 60 years of age or older.

  • At the end of the lifetime 60 months on WFNJ, recipients without exemptions are terminated from the program. Terminated individuals may be eligible for Supportive Assistance to Individuals and Families (SAIF). Convictions for drug distribution convictions after 8/22/96 render an individual permanently ineligible for the program. Those with a drug possession/use conviction after 8/22/96 are eligible for SAIF following a treatment program, negative drug test, and 60 days drug-free. Single adults receive $140 per month, childless couples receive $193, a parent with one child receives $322, and a parent with two children receives $424.
  • Individuals terminated from TANF because of income greater than the eligibility threshold may still receive Medicaid for 24 months.

Emergency Assistance: These benefits are available to people on WFNJ and include, but are not limited to: essential food, clothing, shelter and household furnishings; temporary rental assistance or back rent or mortgage payments; utility payments (such as heat, water, electric); transportation to search for housing; and moving expenses. Eligible persons include those who are homeless or at immediate risk of becoming homeless, and those who have experienced a substantial loss of housing, food, clothing or household furnishings due to fire, flood or similar disaster. Assistance is limited to 12 months, but extensions may be granted under certain hardship conditions, with specific limitations.

Supportive Assistance to Individuals and Families (SAIF): This program provides up to 24 months of cash assistance as well as services such as child care and transportation to those who have exhausted their 60 months on WFNJ and who do not qualify for an exemption to the time limit. Close contact with a case manager is an essential portion of this program. SAIF carries the same work requirements as WFNJ.

Smart Steps: All of the same benefits and services as WFNJ are available, but school attendance may be substituted for work. This program has a limited number of slots, so its availability cannot be guaranteed. Recipients are required to take 12-credits per semester and maintain at least a 2.0 GPA. To be eligible, one must meet the same requirements as WFNJ and:

  • Not already have a college degree;
  • Be responsible for children or other family members who depend on their care;
  • Lack the skills to get a job that will allow them to support their family without depending on outside help;
  • Plan to get a degree that will improve their family’s ability to be self-supporting; and
  • Their employment counselor agrees that they meet these conditions.

Employment counselors may be used for assistance in selecting a program that meets the mandatory long-term employment goals of WFNJ and Smart Steps.

Post-TANF Supplemental Work Support: Employed clients receiving cash assistance who have ebeen working at least 20 hours per week for at least the past four months, , may be eligible to receive $200 per month for up to 24 months. To be eligible, they must have been on WFNJ/TANF for at least six months and agree to voluntarily close their case. Childcare and transportation services are also available during this period. 

Medicaid:

NJ FamilyCare: New Jersey has adopted Medicaid expansion, but continues to refer to categorical eligibility. NJ FamilyCare is an umbrella program that covers Medicaid expansion, traditional Medicaid and CHIP. As NJ FamilyCare is designed as a catch-all, individuals apply for one program and their benefits are determined by need. Applications are handled through an online form or in-person at the county welfare agencies.

The following categories of people are eligible for NJ FamilyCare:

  • Children 18 and under will continue to be eligible with higher incomes up to 350% Federal Poverty Level(FPL).
  • Pregnant Women are covered up to 200% FPL.
  • Parents/Caretaker relatives with income up to 133% FPL must have tax dependent children in their household in order to be eligible under this category. The children must also be insured.
  • Single Adults and Childless Couples must be between ages 19-64 and make no more than 133% of the FPL.
  • The Aged, Blind, and Disabled will be remain eligible, as they were pre-expansion.

Special Program from the Aged, Blind, or Disabled: To be eligible, one must be over 65, blind or disabled, and meet financial eligibility standards. The purpose of the program is to provide Medicaid services to those who meet its demographic requirements, but have not received health coverage due to income or resources greater than the eligibility threshold. Those eligible for the program may also be Qualified Medicare Beneficiaries (QMB), and may be able to obtain assistance with premium payments for Medicare Parts A and B. The income of an applicant’s parents or spouse may have an effect on eligibility. The program uses Social Security Administration counting rules, and imposes limits of a 100% FPL maximum monthly income as well as a $4,000 resource limit for a single adult ($1,261 monthly income and $6,000 resource cap for couples). Individuals deemed disabled by the Social Security Administration are eligible for this program.

NJ WorkAbility: Full Medicaid is available to disabled individuals between 16 and 64 who can pay a small premium. The income limit is $59,148 (250% FPL after disregards) per year. Recipients do not need to work a minimum number of hours. Rather, they just need to prove employment.

Applicants can also have up to $973 (100% FPL) per month ($1,311 for couples) in unearned income. SSD and Railroad Retirement System Benefits do not count as income. The resource limit is $20,000 for single adults, and $30,000 for couples. IRA/401k accounts are not counted as income, nor are first homes or vehicles used for medical transportation or getting to/from work.

Food Benefits:

SNAP benefits: The federal program that distributes benefits through electronic cards for the purchase of food. To be eligible, a single person must make no more than $1,800/month (185% of FPL). People can apply at their county welfare agency or online using the same website to apply for WFNJ (GA/TANF).

Other Benefits:

AIDS Drug Distribution Program (ADDP) This is New Jersey’s AIDS Drug Assistance Program. To be eligible, one must be a resident for 30 days and have annual income less than 500% FPL. A physician validation form and a pharmacist validation are required. There is a formulary of FDA-approved drugs that may be prescribed to patients on the advice of their physician.

Housing: Department of Housing and Urban Development-subsidized apartments and Section 8 vouchers are available in New Jersey for low-income renters. Burlington County Housing Authority (HA) administers low-rent programs, while Camden, Gloucester, and Salem HAs handle both low-rent and Section 8.

  • State Rental Assistance Program: Comparable to the federal housing choice vouchers, this program has set-asides for the elderly, disabled, and homeless. 75% of participants must be under 30 percent of area median income, as defined by region and household size. The other tenants cannot have income that exceeds 40% of low-income limits (by county), as defined in accordance with the HUD guidelines.
  • Homelessness Prevention: Limited emergency funds are available to low-income and moderate-income tenants who are in immediate danger of eviction/foreclosure. Takes the form of loans and grants.

 Applying for Benefits:

Online, through NJ OneApp: Use this website to apply for SNAP and WorkFirst New Jersey.

Board of Social Services/County Welfare Agency: Applications are accepted in person at these offices which, depending on the county, may house both agencies. Each county in New Jersey has its own website for these offices, but be wary of the phone numbers listed as many appear not to have been updated in the past few years. They remain however, a useful starting point for determining which services are available.

 For more information, please consult Title 10 (Human Services) of the New Jersey Administrative Code, freely available here.

Resources:

Cash Assistance Resources:

Medicaid Resources:

SNAP Resources:

 Other Resources:

Application Resources:


PRIVATE BENEFITS:

Private benefits primarily cover three kinds of insurance: health insurance, life insurance and disability insurance.  Insurance policies are legal contracts. Just like any contract, it is important that you read your policy and understand its terms. People living with HIV and AIDS who buy insurance have certain rights. For example, your insurance cannot be canceled because you have HIV or AIDS. You cannot be tested for HIV unless you agree to the test. However, in many cases, insurance companies can legally deny you insurance because you have HIV or AIDS. This means that in some cases, if you do not agree to be tested for HIV, the insurance company can deny you for this reason as well.

Resources:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA).  A federal law that permits qualifying employees to maintain group health insurance after leaving employment. The qualified employee may be required to pay the full cost for the coverage. COBRA coverage has limited duration, but in most cases the maximum COBRA period is 18 or 36 months. Pennsylvania also has a “Mini-COBRA” law that gives employees of small businesses (2-19 employees) who receive health insurance from their employers the right to purchase continuation health insurance after they leave employment. It allows eligible employees and dependents to purchase health insurance for nine months after their employment ends. An employee or dependent eligible for Mini-COBRA coverage may not be discriminated against on the basis of any evidence of inability to be insured. For more information about Mini-COBRA, call the Pennsylvania Department of Insurance at 1-877-881-6388 or click here.

  • HIPAA Creditable Coverage. HIPAA requires that most health plans provide coverage for pre-existing medical conditions and protects the portability and continuity of health insurance coverage.

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