The individual must be a resident of new jersey and a.
Nj family care aged blind disabled programs.
Nj familycare aged blind disabled program application spanish designated authorized representative form this is a supplemental form if you want to designate an authorized representative that will be responsible for the application and the eligibility process.
Aged blind disabled programs including long term care.
Last first middle maiden name.
If you speak any other language language assistance services are available at no cost to you.
It is designed for people whose income and resources are not enough to meet the cost of necessary care.
No yes please complete the spouse information form.
Financial eligibility will be determined by the latest federal tax return which when filed will be electronically verified.
The nj familycare aged blind disabled abd programs provides medical coverage to individuals who are age 65 years or older as well as individuals determined blind or disabled by the social security administration or by the state of nj.
Children pregnant women parents caretaker relatives single adults and childless couples.
State of new jersey department of human services nj familycare division of medical assistance and health services aged blind disabled programs section 1 applicant applicant s name.
Nj familycare aged blind disabled programs cover individuals who are age 65 years or older as well as individuals determined by the social security adminis tration or by the division of medical assistance and health services dmahs as blind or disabled.
Nj familycare aged blind disabled program application.
Nj familycare division of medical assistance and health services aged blind disabled programs section 1 applicant.