Is It Possible to Be Declared Disabled By Social Security or The State of New Jersey, Yet Be Denied Medicaid Because He or She Are Not Medically Disabled?

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Medicaid Attorney

Recently a client aged 55 with Parkinson’s was deemed permanently disabled by Social Security and ineligible to collect SSDI. An application for Medicaid was filed and the state nurse performed a Pre-Admission Screening (PAS). She determined that the person is not medically eligible for a Medicaid assisted living level of care. Doesn’t the Social Security Disability ruling trump the State’s (OCCO’s) medical assessment?

The answer is not necessarily. The fact that someone is eligible to receive SSDI does not mean the person meets the level of care needed for Assisted Living Medicaid. These are two different standards. There are lots of people who cannot engage in meaningful employment – SSDI disabled – who do not require an institutional Medicaid level of care.

The issue, from the state’s perspective, is whether the individual needs hands on assistance in 3 or more activities of daily living (dressing, bathing, transfer, eating, toileting, bed-mobility, and ambulation) or, if cognitively impaired, needs supervision or cueing in 3 or more a combo of supervision/cueing and hands on.

In this case the applicant did not need that much help and so the state was correct.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.