The medicaid special program



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HOW TO APPLY

FOR

THE MEDICAID SPECIAL PROGRAM
What is the Medicaid Special Program?
Medicaid Special is a program which provides full Medicaid services to individuals under 21 who are financially needy.
HOW MUCH INCOME

AND

RESOURCES CAN I HAVE

AND


STILL BE ELIGIBLE?
If your total gross monthly income is less than the following amounts you may be eligible:

MAXIMUM GROSS MONTHLY INCOME LEVELS

Monthly Number in Eligible

Income Unit

$ 243 1

483 2

636 3

732 4

825 5

924 6

WHAT DO I NEED TO APPLY

FOR

MEDICAID SPECIAL?
When applying for Medicaid Special, you will be asked to provide documents concerning your situation. If you have any of the documents listed below, bring them with you when you come to the office. If you do not have them, the worker will help you obtain the ones you need.
BIRTH CERTIFICATES

SOCIAL SECURITY CARDS

RENT RECEIPTS

SCHOOL ATTENDANCE VERIFICATION FOR CHILDREN

GAS, ELECTRIC AND/OR FUEL OIL BILL

TELEPHONE BILL

PROOF OF ALL INCOME AND RESOURCES

MARRAIGE CERTIFICATE

DIVORCE PAPERS

CUSTODY PAPERS

DOCTOR'S SLIP WITH EXPECTED DATE OF DELIVERY, IF YOU ARE PREGNANT

SOCIAL SECURITY OR SSI AWARD LETTER

DEATH CERTIFICATE

ALIEN REGISTRATION, PASSPORT, VISA

COPIES OF HEALTH INSURANCE CARDS
WHAT ARE MY RESPONSIBILITIES?

1,015 7

1,092 8

Add $75.00 More Than

Each Additional 8

Person
The total value of all of your RESOURCES, such as cash on hand and

money in the bank must be NO MORE THAN $2,000.

. To help the welfare agency obtain information needed to determine your eligibility and amount of benefits.
. To notify the welfare agency when you or any family member

moves, gets a job or experiences any change of income, resources

or circumstances.
NOT MEETING ANY OF THESE RESPONSIBILITIES COULD MEAN THAT YOUR MEDICAID SPECIAL BENEFITS WILL DENIED OR STOPPED.


WHERE DO I APPLY?

At the Essex County Division of Welfare Office nearest you. The addresses and telephone numbers are as follows:




18 Rector Street 1st fl., Newark, N J (973) 733-2440
18 Rector Street, 3rd fl., Newark, NJ (973) 733-3183
18 Rector Street, 7th fl., Newark, NJ (973) 733-2360
50 South Clinton Street, East Orange, 2nd fl. (973) 395-8165

(15 Bell Street, Orange, NJ)


50 South Clinton Street, East Orange, 1st fl. (973) 395-8000

HOW TO APPLY




FOR




MEDICAID SPECIAL PROGRAM




BENEFITS




IN




ESSEX COUNTY




Joseph N. DiVincenzo, Jr.

County Executive

Sheila Oliver

Department Director

Department of Citizen Services

Bruce Nigro



Acting Division Director

Division of Welfare


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