NJ FamilyCare is a joint federal and state-funded health insurance program designed to provide affordable health coverage to qualified residents of New Jersey. It caters to individuals and families who do not have access to employer-sponsored insurance, covering a diverse demographic across all ages.

The program offers comprehensive services, including doctor visits, hospitalization, prescriptions, and preventive care. Eligibility for NJ FamilyCare is primarily based on income and household size, with specific considerations for children, adults, pregnant individuals, and special groups like the elderly or disabled.

Applications can be easily made online, allowing for efficient enrollment and management of benefits. Additionally, NJ FamilyCare ensures continuous coverage through a streamlined renewal process, considering changes in income or household circumstances.

New Jersey Medicaid, under NJ FamilyCare, covers a comprehensive array of healthcare services. Here's a summary with brief descriptions for each service:

1. Doctor Visits: Coverage for appointments with healthcare providers for medical evaluation and treatment.
2. Eyeglasses: Provides corrective lenses as prescribed by an eye care professional.
3. Hospitalization: Includes inpatient care in a hospital for various medical conditions and treatments.
4. Lab Tests: Covers laboratory services such as blood tests and other diagnostic testing.
5. X-rays: Provides radiological services for diagnostic purposes.
6. Prescriptions: Covers prescribed medications, subject to formulary guidelines.
7. Regular Check-ups: Includes routine health examinations and preventive care.
8. Mental Health: Covers services for mental health evaluation, counseling, and treatment.
9. Dental: Includes dental care services such as exams, cleanings, and specific treatments.
10. Preventive Screenings: Covers screenings for early detection of diseases like cancer.
11. Autism Services: Provides specialized services and support for individuals with autism.
12. Community Doula Services: Offers support during pregnancy, childbirth, and the postpartum period from trained doulas.
13. Help with Personal Care Needs: Assistance with activities of daily living for people who require support due to health conditions.

Coverage availability can vary based on the individual's family income, and there may be restrictions on certain services. Additionally, while four Health Plans are available in all New Jersey counties, one is not available in Hunterdon County.

The eligibility requirements for Medicaid in New Jersey, under NJ FamilyCare, can be summarized as follows:

Residency

Applicants must be New Jersey residents.

Income and Household Size

Eligibility is primarily based on Modified Adjusted Gross Income (MAGI). This is calculated using the most recent federal tax return, which can be electronically verified. The calculation simplifies income determination by using the tax-based household size.

Children Under 19

• Eligible with incomes up to 355% of the Federal Poverty Level (FPL). For a family of four, this equates to $8,875 per month.
• Annual renewal of coverage is required.
• Children can qualify regardless of immigration status.

Adults Age 19-64:

• Eligible with incomes up to 138% FPL, which is $1,677 per month for a single person and $2,268 per month for a couple.
• Generally, immigrant adults must have had Legal Permanent Resident status in the U.S. for at least five years. However, specific categories, like refugees and asylees, can qualify regardless of how long they have been in the U.S.
• Immigrants ages 19 and 20 who are lawfully present and have very low income (up to $509/month for single persons and $805/month for a family of two) may also qualify.

Pregnant People:

• Eligible with incomes up to 205% FPL, which is $5,125 per month for a family of four.
• Lawfully present pregnant individuals can qualify regardless of their date of entry into the U.S.

Special Categories

People over age 65, those who are blind or disabled, in long-term care, or adults aged 19-64 with Medicare have different eligibility criteria.

Be sure to check the most current guidelines, as these figures and policies can change. Additionally, specific circumstances, such as immigration status and individual health needs, can affect eligibility.

To apply for Medicaid in New Jersey, follow these steps:

Apply Online

This is the fastest and easiest method. You can apply through the NJ FamilyCare website.

Create an Account

When applying online, you can create an account that allows you to:

1. Save partially completed applications.
2. View submitted applications.
3. Receive future Medicaid notifications electronically.

Assistance

If you have questions or need help with the application, call 1-800-701-0710 (TTY: 711).

Applying online and setting up an account is advantageous as it streamlines the application process and helps track and manage your application efficiently.

To renew your eligibility for NJ FamilyCare (New Jersey Medicaid), here's a summary of the process:

1. Income Data Consent: By agreeing to renew, you permit NJ FamilyCare to use your income data, including tax information, to redetermine your eligibility.
2. Renewal Notice: NJ FamilyCare will send you a renewal notice when it's time to renew your coverage.
3. Updating Information: Upon receiving the renewal notice, you'll have the opportunity to update any changes in your or your household's eligibility information.
4. Withdrawal Option: You have the right to withdraw your request for benefits at any time, which must be done in writing.

This process ensures that your eligibility is accurately assessed based on the most current information and allows for any necessary adjustments based on changes in your circumstances.