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LEGAL TOPICS
NJ FamilyCare 2020 Income Eligibility Levels
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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.


On Feb. 19, 2020, the New Jersey agency that administers all NJ FamilyCare programs published income eligibility levels for 2020. This is part of a regular process each year in which NJ FamilyCare income eligibility levels are updated based on increases in the federal poverty guidelines that are announced in January.

Even though New Jersey did not publish the 2020 income eligibility levels until late February, they are effective retroactively to January 1, 2020. This means that if you were denied or terminated from NJ FamilyCare in early 2020 for being slightly over the income limit, that determination may have been incorrect because it was based on outdated 2019 income limits. You can appeal or file a new application, asking that your eligibility be reconsidered under the 2020 guidelines and restored retroactively to the month in which you originally applied.

It is important to know that NJ FamilyCare is not just one program with one set of eligibility criteria. Rather, NJ FamilyCare is the umbrella name given to all of New Jersey’s health coverage programs for low-income residents. It includes all of New Jersey’s Medicaid and CHIP (Children’s Health Insurance Program) programs. So, if you or your children are not eligible for one NJ FamilyCare program, you may be eligible for another one.

What programs fall under the NJ FamilyCare label?

ACA Medicaid Expansion

Probably the most common NJ FamilyCare program is the ACA Medicaid Expansion for adults ages 19 to 64. The central eligibility criterion is having income at or below 138% of the federal poverty level (FPL). For 2020, for a person applying as a single individual, 138% FPL, is $1,468 per month or $17,609 per year. (By contrast, 138% FPL in 2019 was $1,437 per month, or $17,237 per year.) The only other eligibility criteria are ineligibility for Medicare and certain immigration-related restrictions. People who qualify for this program pay no premiums or cost-sharing. A full listing of the eligibility limits for different household sizes is provided in the chart below.

2020 Income Limits
ACA Medicaid for Adults 19-64
(138% FPL)

Household
Size

Annual

Monthly

1

$17,609

$ 1,468

2

$23,792

$ 1,983

3

$29,974

$ 2,498

4

$36,156

$ 3,013

5

$42,339

$ 3,529

6

$48,521

$ 4,044

7

$54,704

$ 4,559

8

$60,886

$ 5,074

+1

$ 6,183

$ 516

Child coverage through Medicaid and CHIP

There are also NJ FamilyCare programs that supply coverage for low-income children. These include both Medicaid and CHIP. The services provided by these programs, as well as the premiums and cost-sharing, differ depending on the income of the household. For example, children in households with income below 147% FPL receive the most generous benefit package with no premiums or co-pays. For a household of four, 147% FPL in 2020 is $3,101 per month or $37,204 per year. Children in families with income up to 355% FPL ($7,751 per month or $93,010 per year for a household of four in 2020) are eligible for a NJ FamilyCare CHIP program, but their benefit package is less generous and parents pay a premium of $152 per month and co-pays ranging from $5 to $35.

NJ Aged, Blind, and Disabled Programs

Another category of NJ FamilyCare programs are those for the aged (65 and over), blind, and disabled (ABD). For example, there is a “NewJersey Care” ABD program for persons with income up to 100% FPL, which, in 2020 is $1,064 per month or $12,760 for a single individual. In addition to income limits, NJ Family Care ABD programs have resource limits (e.g., $4,000 for a single individual in the 100% FPL program) and some immigration restrictions. Other NJ Family Care ABD programs, including the Medicaid Workability program and Long Term Care Medicaid (often referred to as MLTSS), have different income and resource limits. For the most part, these programs have no premiums or co-pays.

Calculating your income

One important difference between the ABD programs and most other NJ FamilyCare programs is the method for calculating income. The non-ABD programs generally use a method called “modified adjusted gross income” or MAGI, which uses basically the same rules used by the federal income tax system in calculating adjusted gross income. For more information about MAGI, see Medicaid Eligibility and the Modified Adjusted Gross Income (MAGI) Method of Calculating Income​. By contrast, ABD programs use traditional Medicaid income counting rules. For example, these rules include an automatic $20 disregard in counting income, which means that the 2020 income limit for the NJ Care ABD program at 100% FPL of $1,064 (referred to previously) is effectively $1,084 per month.

Bottom line

If you are denied or terminated from any NJ FamilyCare program, make sure that the agency is using the 2020 (not 2019) income guidelines, and that the agency has also considered your eligibility for all other NJ FamilyCare programs. See NJ FamilyCare for more information about the NJ FamilyCare program, including how to apply. See The NJ FamilyCare Aged, Blind, Disabled Programs (from the NJ Department of Human Services) for information specifically about NJ FamilyCare ABD programs, including how to apply.                            

 

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4/8/2020
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