Research on Employment Supports for People with Disabilities: Summary of the Focus Group Findings. Public In-Kind Support


In-kind support consists of goods and services that are provided free of charge. Examples of public in-kind support include food stamps, housing subsidies, and health insurance. In-kind supports function as income, because absent the supports recipients would need to purchase the goods or services on their own.

Medicaid. In New Jersey, Medicaid pays for hospital, doctor, prescription drug, nursing home and other health services for approximately 600,000 low-income children and pregnant women and people who are blind, elderly and disabled. Medicaid includes the following programs:

  • The New Jersey Care Program includes a special Medicaid Program for pregnant women and infants and a program for people who are aged, blind or disabled. The New Jersey Care Program for the Aged, Blind and Disabled provides Medicaid coverage to eligible people 65 or older, or blind, or permanently and totally disabled persons. The income standard is set at 100 percent of the federal poverty level. In New Jersey, Qualified Medicare Beneficiaries (QMBs) are eligible for benefits.

  • The Medically Needy component of the New Jersey Care Programs enables individuals whose income is too high to qualify for the regular Medicaid program to apply their excessive medical bills to spend down to the program's income limit.

  • HealthStart provides expanded maternal and child health care coverage to pregnant women and children under age two in New Jersey who are eligible for Medicaid benefits. The program provides an enhanced set of Medicaid benefits to eligible pregnant women during their pregnancy and for 60 days following delivery or the date the pregnancy ends. Children up to the age of two years are also eligible for enhanced health care services.

  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a comprehensive health program for Medicaid-eligible beneficiaries under 21 years of age. The program encourages regular medical and dental check-ups in order to prevent or identify problems before they become more serious. The program's services include periodic health check-ups, developmental and nutritional appraisal, vision and hearing screening, immunizations, dental referral for children three years of age and older, laboratory tests, health education, guidance, and diagnosis and treatment.

  • New Jersey Care 2000 is New Jersey's mandatory managed care program, implemented September 1995. Under New Jersey Care 2000, the state contracts with HMOs to provide a comprehensive set of Medicaid health care services. The program is mandatory for TANF and TANF-related Medicaid populations. The program is voluntary for the Division of Youth and Family Services (DYFS) Medicaid population and the SSI Medicaid population. Currently, New Jersey Care 2000 is operational in all 21 counties and there are 387,954 Medicaid beneficiaries enrolled in the program.83

  • New Jersey KidCare provides a comprehensive package of health care services through health maintenance organizations (HMOs) for children and teens in New Jersey who do not have health insurance coverage. The services include well child and other preventive services, hospitalization, physician care, lab and x-ray services, prescription drugs, mental health services, vision and other services. Uninsured children 18 years of age and under may be eligible. Eligibility for NJ KidCare is based on the number of people in the family and the family's total income. The maximum income for a family of two is $28,840; the maximum income for a family of four is $58,450.

Additionally, there are several waiver programs administered by the Bureau of Home and Community Services (BHCS). The Division of Medical Assistance and Health Services (DMAHS) implemented these waivers by utilizing opportunities available under Section 1915(c) of the Social Security Act. Case management is mandatory under all 1915(c) waivers.

Waiver programs include the following:

  • AIDS Community Care Alternatives Program (ACCAP): This program is designed to serve disabled children and adults who are diagnosed as having AIDS and are in need of institutional care at home. Children under 13 diagnosed as HIV positive are also eligible for this program. In addition to all State Plan services, these individuals can receive eight additional services not permitted under regular Medicaid.

  • Model Waivers I, II, III: These programs provide community-based services for disabled children and adults who meet nursing facility level of care criteria. The cost of these services must not exceed the cost of institutionalization of the beneficiary.

  • Home and Community-Based Services Waiver for the Developmentally Disabled: This program is administered by the Division of Developmental Disabilities (DDD) with DMAHS providing oversight. The program provides community-based services for developmentally disabled individuals who meet certain levels of care criteria.

  • Home and Community-Based Services Waiver for Medically Fragile Children: Known as the ABC Waiver, this program is administered by the Division of Youth and Family Services (DYFS) in cooperation with staff from BHCS. The ABC Waiver program is designed to assist eligible children who are in need of nursing facility or hospital setting services in receiving the medical care necessary to remain in the community or return to it.

  • Traumatic Brain Injury (TBI) Waiver: This program is designed to provide community alternatives for brain injured individuals using nursing facilities or who are in the community and at risk for placement in nursing facilities. The population served primarily consists of young adults who are ambulatory with cognitive, behavioral and physical problems requiring supervised and supported care. Most individuals involved have either completed or would no longer benefit from a course of intensive rehabilitation.

Medicare. Medicare is a Health Insurance Program for individuals 65 years old and older; some people with disabilities under 65 years of age; and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). The Health Care Financing Administration (HCFA) administers Medicare, covering 39 million Americans. Medicare has two parts:

  • Part A subsidizes care in hospitals, skilled nursing facilities, hospice, and some home health care. Beneficiaries with a sufficient earnings history do not pay a premium for Part A.

  • Part B helps pay for doctors, outpatient hospital care, and some other medical services not covered under Part A, including services of physical and occupational therapists, and some health services. Part B helps pay for covered medically necessary doctor services. Consumers are responsible for the monthly Medicare premium of $45.50. The cost of Part B may increase 10 percent for each 12-month period that an individual has Part B but did not take it. Enrollment in Part B is optional; the premium is usually deducted from Social Security, Railroad Retirement, or Civil Service Retirement payment.

The original Medicare plan is available everywhere in the United States. It is the most common plan for receiving Medicare Part A and Part B benefits. An individual may go to any doctor, specialist, or hospital that accepts Medicare. Some people also have access to Medicare Managed Care Plans. Under the Managed Care Plan, an individual is restricted to doctors, specialists and hospitals that are part of the plan. Plans must cover all Medicare Part A and B benefits. Some plans cover extras, like prescription drugs. Private Fee-for-Service Plans is a new health care choice in some regions of the country. An individual may still see any doctor, specialist, or hospital. Plans must cover all Medicare Part A and B benefits. Some plans include extras, such as extra days in the hospital. The plan, not Medicare, determines the cost to the consumer.

Federal Food Stamp Program. New Jersey administers the federal Food Stamp program, enabling eligible WorkFirst New Jersey participants to receive cash benefits to help pay for food. Other individuals who may also be eligible for the Food Stamp Program include low-income individuals and families who are not on welfare and those who move off public assistance. The County Welfare Agency determines eligibility.

Electronic Benefits Transfer (EBT) System. The Division has created a "Families First" debit card through the Electronic Benefits Transfer System, funded with federal dollars from the TANF Block Grant. EBT enables welfare recipients to purchase food and receive case benefits. The system is time- and cost-effective for merchants because it eliminates the use of food coupons. Currently, the card excludes Medicaid benefits. However, Medicaid is looking to have benefits accessible by card also.84

Home Energy Assistance Program. The Low Income Home Energy Assistance Program (LIHEAP) is a statewide program, funded by the federal Low-Income Home Energy Assistance Program Block Grant. The program is jointly administered by the New Jersey Department of Human Services, The Division of Family Development and the Department of Community Affairs. LIHEAP provides subsidies to help low-income families pay the cost of home heating bills. The gross monthly income of a family determines the family's eligibility for this program. An individual is eligible if he or she has a gross monthly income less than $1,030. A family of four is eligible the household gross monthly income is less than $2,088. Families may also be eligible for assistance with expenses related to medically necessary cooling costs.

In fiscal year 2000 (October 1, 1999-September 30, 2000), the federal allocation for the LIHEAP program was $41 million. The state also received supplemental federal funding totaling $20 million from the Emergency Contingency Fund.85

Supportive Housing for Persons with Disabilities. The Supportive Housing for Persons with Disabilities program, administered by the Department of Housing and Urban Development, provides interest-free capital advances to nonprofit organizations that build, rehabilitate, or purchase rental housing to be used as supportive housing for persons with disabilities. The advance is interest free and does not have to be repaid, as long as the housing remains available for very low-income persons with disabilities, for at least 40 years.

Special Needs Programs86

  • The Scattered Site AIDS Permanent Housing Program: The New Jersey Housing and Mortgage Finance Agency (NJHMFA), four nonprofit care providers, the Department of Health and Senior Services, the New Jersey Department of Human Services and the New Jersey Department of Community Affairs (DCA) created the Scattered Site AIDS Permanent Housing Program. The program provides a total of 34 units of permanent housing for persons with HIV/AIDS and their families, or approximately 125 people in five municipalities.

  • The Transitional Housing Revolving Loan Program: In 1989, the NJHMFA authorized $4 million in Agency reserves for the implementation of this program. The program was part of an inter-agency initiative between NJHMFA, the New Jersey Department of Community Affairs and the New Jersey Department of Human Services. The program makes a "0" percent construction loan and/or a permanent loan with an interest rate not to exceed "5" percent for a term ranging from five (5) years to a maximum of thirty (30) years for eligible projects. The program is targeted to homeless families and their children, homeless individuals including victims of domestic violence, persons with HIV/AIDS and other persons with special needs. Since the program's inception and through September of 1998, it has financed thirteen (13) projects with 228 units by committing approximately $4.5 million and generating $17 million in additional local, State, Federal and private resources.

  • The New Jersey Supportive Housing Program: This program is a cooperation of the New Jersey Department of Community Affairs (DCA), the New Jersey Department of Human Services (DHS), Division of Mental Health Services, the NJHMFA and the Corporation for Supportive Housing (CSH). It has been established to encourage non-profit developers and sponsors to develop high quality and affordable housing for individuals or families in New Jersey who are homeless or at risk of homelessness. This program is specifically targeting individuals or families in New Jersey where at least one person is coping with mental illness, substance abuse problems, HIV/AIDS, or other chronic medical and mental disabilities. A CSH New Jersey State Advisory Committee, including representatives of NJHMFA, DCA and DHS, is providing CSH with guidance and counsel regarding the program including its annual budget and program actions.

  • The Shelter-Plus Care Initiatives: NJHMFA has collaborated with community groups to use State and private grants of $1.9 million to administer the acquisition and renovation of 16 units (49 beds) of previously abandoned properties in Camden County to house and provide care for homeless individuals with serious, persistent and chronic mental illness and substance abuse problems. A consortium of health care providers, UMDNJ, South Jersey Behavioral Health Resource Inc. and the Steininger Center, has committed funds for the outreach and supportive services for the residents. In addition, a federal grant of $1.8 million has been received by the project for rental assistance over ten years.

    The most recent Shelter Plus Care Initiative is a 32-unit project in the City of Paterson which is currently serving homeless persons and families with mental health and/or substance abuse problems and persons with HIV/AIDS. NJHMFA has worked with the Paterson Coalition for Housing, Inc. to provide $5.2 million in State, Federal and private resources to administer the acquisition and rehabilitation of the project. A consortium of local non-profits, in coordination with the sponsoring Agency, is providing outreach and supportive services to the clients. The Federal government has provided a grant in the amount of $4 million for rental assistance over ten years.

  • The Home of Your Own Program: The NJHMFA and the New Jersey Developmental Disabilities Council are collaborating to provide an opportunity for individuals with developmental disabilities to achieve home ownership. Under a grant provided by the New Jersey Developmental Disabilities Council, the NJHMFA has employed a program coordinator to carry out the mission and goals of the program. The mission and goals include, but are not limited to, fulfilling the grant commitment of placing individuals into a home ownership opportunity, researching and identifying the needs of people with disabilities and barriers to securing housing opportunities, developing a public outreach campaign, and developing a home ownership counseling program to address the needs which are identified for people with disabilities.

  • Home Ownership for Permanency Project: The NJHMFA and the Division of Youth and Family Services (DYFS) are partners in a demonstration project to help abused, neglected, abandoned or orphaned children, including those defined by DYFS as "Child(ren) with Special Needs," to achieve a permanent placement with relative caregivers or adoptive families. To the extent practicable, NJHMFA will make loans to eligible borrowers through the Agency's Home Buyer Program. Additional financial products under this demonstration include loans made completely from the Agency's allocation of funds for families that do not meet standard Agency underwriting guidelines but who are creditworthy, rehabilitation loans for families who currently own their own home but need to make necessary improvements to accommodate the newly adopted children or combination refinance and rehabilitation loans. One of the goals of the project is to maintain flexible underwriting guidelines in order to maximize the number of families served by this demonstration program.

The New Jersey Technology Assistive Resource Program (TARP). TARP is New Jersey's Assistive Technology project under the Assistive Technology Act of 1988. The project's purpose is to overcome system barriers and make assistive technology (AT) more accessible to individuals with disabilities throughout the state. AT includes devices and services created and used to help people with disabilities live more independently and productively. New Jersey TARP operates as an integral part of New Jersey Protection and Advocacy, Inc. TARP services include information and referral, advocacy services, legal representation, supporting access to used AT devices, presentations and outreach, and interagency coordination.87

TTY Distribution Program. The Division of the Deaf and Hard of Hearing (DDHH) distributes free Text Telephones to qualified indigent Deaf and hard of hearing New Jersey residents. In the last seven years, the Division distributed 1,233 free TTY's. The program has given Deaf and hard of hearing people access to any telephone number in the world now that telephone relay services are required to be provided by states by Title IV of the ADA and regulated by the Federal Communications Commission. This program affords many individuals a greater opportunity to seek employment and become more independent.

Statewide Communication Access Network. The Division of the Deaf and Hard of Hearing (DDHH) houses New Jersey's primary sign language interpreter referral service which also handles requests for assistive listening equipment and captioning services. Sign language interpreters facilitate communications between Deaf people and individuals not familiar with American Sign Language. Requests for sign language interpreters are received by the Coordinators of Interpreter Referral Service (IRS). The coordinators contact individual vendor interpreters in the DDHH directory.

Currently, there is a greater general awareness of the communication assistance required by Deaf people and a shortage of qualified sign language interpreters. Therefore, the workload has increased significantly; the IRS has handled 1,796 requests during the last fiscal year. It also provides assistive listening equipment and captioning services which permit those with hearing loss to participate in the dialogue around them.