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LEGAL TOPICS
New Medicaid Eligibility Group for Family Planning Services
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MEDICAID TERMINATIONS BARRED DURING CORONAVIRUS EMERGENCY

Federal legislation passed on March 18, 2020 bars all Medicaid terminations during the course of the public health emergency caused by COVID-19. In New Jersey, all Medicaid programs are considered part of NJ FamilyCare. If you were enrolled in Medicaid as of March 18, those benefits must be continued, unless you move out of state or voluntarily request termination, until the last day of the month when this public health emergency is officially ended.


Federal Medicaid law requires that states cover family planning services and supplies for everyone who is eligible for Medicaid. States also have the option to offer these family planning services to some people who are not eligible for full Medicaid services. As of October 1, 2019, New Jersey adopted this option and became the 26th state to offer family planning services to a group of persons otherwise not eligible for Medicaid. This new program, called Plan First, is offered as part of the NJ FamilyCare program.

Who is eligible for this new coverage?

This coverage is available to persons whose income is above the limit for full Medicaid coverage under the Affordable Care Act (ACA), but is at or below 205% of the federal poverty level (205% FPL). The income limits for 2020 are listed in the chart below. The coverage is available to both women and men. Like other New Jersey Medicaid programs, Plan First requires that you must be a New Jersey resident and either a U.S. citizen or “qualified” immigrant.

Household Size
2020 Plan First
Income Limit
(205% FPL)
 
Annual
Monthly
1
$26,158
$2,180
2
$35,342
$2,946
3
$44,526
$3,711
4
$53,710
$4,476
5
$62,894
$5,242
6
$72,078
$6,007
7
$81,262
$6,772
8
$90,446
$7,358
+1
$9,184
$766


What family planning services and supplies are covered?

Most birth control methods are covered, but a prescription is needed. These include condoms, birth control pills (including the “morning after” pill), the birth control shot, and IUDs. Among the other services that are covered are family planning counseling, family planning lab tests, pregnancy tests, tubal ligations, and vasectomies.

How do I apply for this new program?

You can apply by filing the general NJ FamilyCare application for health care coverage and by answering yes to the question of whether you want to be evaluated for family planning services (Plan First Program). You can apply online at Apply for NJ FamilyCare (from NJ FamilyCare). You can also apply by phone by calling 1-800-701-0710, by mail, by submitting a completed application, or in person by going to a NJ FamilyCare office or a county welfare agency near where you live. See County Boards of Social Services (from the New Jersey Department of Human Services).

Where can I go to get family planning services?

You may obtain services from any provider that provides family planning services “fee-for-service” for the NJ FamilyCare program. These include most Federally Qualified Health Centers (from NJPCA) and most Planned Parenthood clinics: See Health Centers in New Jersey. For a list of all providers in your area, you can contact a Medical Assistance Customer Center (from the New Jersey Department of Human Services) serving your county.

Is Plan First coverage sufficient to meet the NJ individual health insurance mandate?

New Jersey is one of only two states in the country to impose a tax penalty for individuals who did not have health insurance coverage for all or part of the year. (The federal “individual mandate” ended in 2018.) Since Plan First coverage is limited to family planning services, it is not considered “minimum essential health coverage” that lets you avoid the NJ tax penalty if you don’t have other coverage. (You can, however, apply for an exemption from this tax penalty on other grounds, such as affordability.)

Can I have Plan First coverage and other health insurance coverage?

Yes. If you have other health insurance coverage, your other plan will be billed first for all services. If a family planning service is not covered by your other plan, then Plan First will cover it. If the service is covered by your health insurance plan but there is a balance due, Plan First will be billed for the balance.

Will I have cost-sharing expenses with Plan First?

If Plan First is the only health insurance coverage you have, you will not be charged any out-of-pocket expenses. If you also have other health insurance coverage, it is possible that you will be billed for co-pays, co-insurance, or deductibles by your other plan. ​​​​​​​​​​​​​​​

3/26/2020
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