Check to see if you are eligible

Are your children under 19 years old? Have you been told that your children are eligible for free or low-cost NJ FamilyCare health insurance coverage but that you or their other parent or caretaker makes too much money to be eligible?

On March 1, 2010, the rules for parent eligibility for NJ FamilyCare changed for new applications. The maximum income for new applicant parents of children under 19 years old to qualify for NJ FamilyCare was substantially reduced. If you were already receiving NJFC benefits as a parent prior to March 1, 2010, or had applied before that date, you should continue to be eligible if your income remained at or below 200% of the federal poverty level (FPL). Please check chart 1 below to see if you should have been grandfathered in under this category. There is no asset limit.

Chart 1: NJ FamilyCare Income Eligibility for Parent Applications (200% Federal Poverty Level)

If you applied as a new applicant on or after March 1, 2010, you would only be eligible if your family’s unearned income (such as unemployment insurance, child support, Social Security benefits) is at or below the very low 1996 welfare standard (see chart 2 below), and your total combined (earned and unearned) income is at or below 133% FPL (see chart 3 below).

Chart 2: Total unearned income must be at or below the 1996 welfare standard

Chart 3: Total household income must be at or below 133% FPL

Also, as a new parent applicant, you must have been without health insurance for three months to be eligible.  There are some exceptions: (1) you became unemployed through no fault of your own and lost your health coverage under an employer’s group plan; (2) you are on COBRA coverage or you have a commercial Individual Health Policy; or (3) your COBRA coverage under a group plan expired. You also may not be on Medicare, Medicaid, or NJ FamilyCare.

It is important to know that the state and county Medicaid agencies are currently treating many parents who continuously received NJFC benefits since before March 1, 2010 (often for many years before) as new applicants subject to the harsher eligibility rules when their eligibility is reviewed at the time of annual renewal. Legal Services of New Jersey has successfully challenged many of these terminations as violating the NJFC regulations, and we are awaiting a ruling from a New Jersey appellate court to determine whose interpretation of the regulations is correct.

If you are the parent(s) or caretaker(s) of a child who is younger than 19 and you think you may be eligible for NJ FamilyCare, please contact NJ FamilyCare immediately at 1-888-701-0710 and ask for an application. You may also download an application from their website. Depending on your family income, you may have to pay a small monthly premium. However, as of July 1, 2009, NJ FamilyCare no longer charges a premium for children with family income below 200% of the poverty level.

If you are a parent and have been continuously receiving NJFC benefits since prior to March 2010, but you received a termination notice upon annual renewal and you believe you have been wrongly terminated, you may file for an appeal of that termination. If you would like assistance with this issue, you may contact Legal Services of New Jersey and ask for review, advice, and/or possible representation on your case.

Please remember that children can be eligible for NJ FamilyCare with a much higher family income (up to 350% of the poverty level). If you think that you and/or your children are eligible for NJ FamilyCare and your application is denied or you are terminated, please contact your nearest Legal Services office or call LSNJ-LAW™, Legal Services of New Jersey’ statewide, toll-free legal hotline, at 1-888-LSNJ-LAW (1-888-576-5529) for legal assistance. Hotline hours are Monday through Friday, 8:00 a.m. to 5:30 p.m.

This information last reviewed 5/11/12