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LEGAL TOPICS
Applying for NJ FamilyCare
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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.


Prior to 2014, New Jersey had used the NJ FamilyCare label in a variety of ways. Sometimes it was used to refer to the health insurance coverage that was provided to some New Jersey parents and children under the Children’s Health Insurance Program (CHIP), rather than Medicaid. With the implementation of coverage changes under the Affordable Care Act (ACA), particularly the Medicaid Expansion, New Jersey decided to change the NJ FamilyCare label. As of January 2014, it refers to all Medicaid and CHIP programs administered by the State of New Jersey. All New Jersey Medicaid programs are included, whether they cover childless adults, parents, pregnant women, or children, and whether eligibility is based on income, disability, age, or other factors.

General Eligibility

To be eligible for the NJ FamilyCare program, you must meet certain financial requirements. You must also be a resident of New Jersey and be a U.S. citizen or have a qualified immigration status.

Qualifying Solely by Income

Since the ACA changes were implemented in 2014, you may qualify for Medicaid based solely on your income. The income limits depend on whether you are an adult (up to 65th birthday and without Medicare), a child (up to 19th birthday), or a pregnant woman, as shown in the table below.

2020* INCOME ELIGIBILITY LEVELS FOR MEDICAID AND CHIP

Family size

Adults 138%


Pregnant Women 205%

Children to 147% (Medicaid)

Children 147% to 355% (CHIP)

1

$ 17,609

$ 26,158

$ 18,758

$ 45,298

2

$ 23,792

$ 35,342

$ 25,343

$ 61,202

3

$ 29,974

$ 44,526

$ 31,929

$ 77,106

4

$ 36,156

$ 53,710

$ 38,514

$ 93,010

5

$ 42,339

$ 62,894

$ 45,100

$ 108,914

6

$ 48,521

$ 72,078

$ 51,686

$ 124,818

7

$ 54,704

$ 81,262

$ 58,271

$ 140,722

8

$ 60,886

$ 90,446

$ 64,857

$ 156,626

* Income is calculated based on the Modified Adjusted Gross Income (MAGI)​ method.
** Pregnant woman and unborn child count as family of 2.

Qualifying Based on Other Reasons

There are also many Medicaid programs that provide coverage based on other reasons including disability and age. The financial eligibility rules for these other categories look at both income and resources. The income counting rules are different than the MAGI rules.

Here are some examples:

  • Persons who are receiving Supplemental Security Income (SSI)
  • Persons who are age 65 or older, blind, or disabled, but whose income or resources are somewhat higher than the SSI limit
  • Persons who are in nursing homes
  • Persons who would be medically eligible for nursing home care, but who are able to receive care in home and community-based programs
  • Uninsured women diagnosed with breast or cervical cancer
  • Persons who require emergency care who would be eligible for Medicaid but for their immigration status
  • Certain low-income Medicare beneficiaries

New Jersey has also opted to provide a "medically needy" program for certain categories of individuals who would otherwise be eligible for Medicaid except that they have income or assets that exceed the Medicaid limits. This option allows pregnant women, children under the age of 21, and persons who are aged, blind, or disabled to spend down their excess income on documented medical expenses to meet Medicaid eligibility limits.

Services

Title XIX of the Social Security Act requires states to provide certain basic services to specific categories of persons under the state's Medicaid program. The following services are federally mandated:

  • Inpatient and outpatient hospital services
  • Physician services
  • Medical and surgical dental services
  • Nursing facility (NF) services for individuals aged 21 and older
  • Home health care for persons eligible for NF services
  • Family planning services and supplies
  • Rural health clinic services and any other ambulatory services offered by a rural health clinic that are otherwise covered under the State Plan
  • Laboratory and x-ray services
  • Pediatric and family nurse-practitioner services
  • Federally qualified health center services and any other ambulatory services offered by a federally qualified health center that are otherwise covered under the State Plan;
  • Nurse-midwife services (to the extent authorized under State law)
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services for individuals under 21.

States may also receive matching federal monies if they choose to provide other Medicaid-covered services. New Jersey provides these optional Medicaid-covered services to eligible individuals:

  • Treatment in residential treatment centers
  • Optometry services and eyeglasses
  • Dental care
  • Prescription medicines
  • Chiropractic services
  • Psychologist services
  • Prosthetics and orthotics
  • Podiatry services
  • Prescription medicine necessary during long-term care
  • Durable medical equipment
  • Hearing aid services
  • Transportation
  • Personal care services
  • Licensed practitioner services
  • Private duty nursing
  • Services in a clinic
  • Physical, occupational and speech therapy
  • Inpatient psychiatric care for individuals under 21 and over 65
  • Intermediate care facilities for the mentally retarded.

Applying for NJ FamilyCare in New Jersey

You can apply for NJ FamilyCare online at NJFamilyCare or print out an application from their website and mail it to their office; ; or by phone at 1 (800) 701-0710. You can also apply in person at your county welfare office.

Most NJ FamilyCare beneficiaries in New Jersey are required to join a participating HMO to receive most of their health care services. There are currently five NJ FamilyCare HMOs in New Jersey. For more information about these HMOs, visit NJ Medicaid & Managed Care (from the New Jersey Division of Medical Assistance and Health Services).​​​​

3/20/2020
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