New Jersey adults and families with extremely low income and resources may qualify for welfare programs that provide a small cash benefit and limited medical coverage. This program is called the "Work First New Jersey" program because adults receiving the benefits must typically work (or be looking for work) to collect the benefit. If the adult is unable to work because of disability, it must be documented using the MED-1 form. That is where you, the medical care provider, come in.
I. What are the two programs?
Adults with no children may use the General Assistance (GA) program. GA generally pays $140 per month and provides a limited medical coverage known as "Plan G." A person with a documented disability may receive as much as $210 per month. As with SSI, any other significant income can reduce the GA benefit.
Families with minor children may qualify for the Temporary Assistance for Needy Families (TANF) program. The TANF program provides a small cash benefit based on the family size, and the beneficiaries typically receive Medicaid HMO coverage. Both GA and TANF benefits are typically limited to five years during a lifetime, although there is a Supportive Assistance to Individuals and Families (SAIF) program that provides additional support in some circumstances.
The meager cash benefits provided by GA and TANF are insufficient to meet most basic needs. However, participation in the programs is an important way beneficiaries can receive some medical coverage. Also, they may sometimes qualify for emergency assistance and help finding emergency housing through the County Boards of Social Services.
II. Why is your opinion needed?
Your patients who qualify for GA or TANF and who cannot work because of disability will need to periodically submit MED-1 forms to the program caseworkers at the County Board of Social Services. Failure to timely supply the completed MED-1 forms might result in your patients losing their medical coverage, cash benefits and/or housing. The program caseworkers typically warn beneficiaries that their benefits will be cut if the MED-1 forms are not provided within a certain number of days. For that reason, and because of the high stakes, your patients may be worried or insistent regarding completion of the forms.
III. Filling out the MED-1 form
MED-1 forms allow you to document your patient's medical condition and state whether they can do work activity. A copy of the form is attached in the appendix to these materials.
The MED-1 form contains instructions to assist you in providing information. Some key points:
- It should be completed by a physician, psychologist or advanced practice nurse.
- If a patient’s only medical problem is substance abuse, then they should not be considered unable to work, but should be recommended for participation in a substance abuse program.
- The form asks you to consider the length of disability.
- Make sure to specify work limitations in detail even if you feel the patient could do some kind of work.
- Consider whether your patient could sustain full-time work. For example, some patients with episodic impairments (e.g., grand mal seizures) might be fine some of the time, but might lose jobs frequently when they become symptomatic.
Ethical Considerations If You Think Your Patient Could Work
What should you do if you a patient asks you to complete a work deferral or Social Security disability report, and you do not believe he/she is disabled? Of course, you cannot certify that a person is disabled in that situation. There are still some things that you can legitimately do to assist your patient:
- Make appropriate referrals. The New Jersey Division of Vocational Rehabilitation Services (DVRS) can help your patients identify jobs that would be realistic to perform within their educational, vocational, and medical abilities. A link to DVRS is provided below. The New Jersey One-Stop Career Centers can also help your patients find jobs.
- If your patient has some limitations, document them fully even if you believe there is some work the patient can do. This will help prevent your patient from attempting work duties that might be medically contraindicated and which might exacerbate their condition. It will also assist any vocational specialists and other employment agency workers in helping your patient find jobs that are appropriate and reasonably within their abilities. This is also a good approach to take if you are not sure if your patient could hold a job. Thoroughly document the patient’s limitations, and then a vocational specialist can determine if any existing jobs are appropriate, considering those limitations.
- If other physicians also treat the patient, please indicate that they may need to be consulted in your report. This will prevent misunderstandings from lack of coordination that could harm your patient.
- Document any accommodations that your patient may need to be able to work. The Job Accommodation Network (link at the end of these materials) is a good resource for such information and contains an “A-Z List” of medical conditions along with potential job accommodations for each one.
This information last reviewed 3/29/12