Medicaid is a government health insurance program that helps people with low income get health care services at a lower cost. In New Jersey, there are several NJ FamilyCare programs, each with its own coverage group and requirements.

What does NJ FamilyCare (Medicaid) cover?

NJ FamilyCare programs pay for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most NJ FamilyCare programs also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the programs serve those with limited income and resources, people with NJ FamilyCare pay few to no out-of-pocket costs. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

NJ FamilyCare is administered by the New Jersey Department of Human Services (DHS) - Division of Medical Assistance and Health Services. Call DHS at 1-800-701-0710 (TTY: 711) to learn more about the coverages provided.

How do I know if I qualify for NJ FamilyCare (Medicaid)?

In general, to be eligible, you must:

• Be a New Jersey resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and (if applicable) resource limits for your coverage group

If you need help with your health care coverage and costs, you should apply for NJ FamilyCare even if you think you are over the income limit. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance.
• If you are over the income limit, but you have very high medical costs, you may be able to qualify through the Medically Needy Program.

What are the different NJ FamilyCare (Medicaid) programs?

You may be able to get health coverage if you fall into one of the following NJ FamilyCare Aged, Blind, and Disabled (ABD) categories.

Supplemental Security Income (SSI)

NJ SSI Medicaid is for people who get Supplemental Security Income. If you get SSI, you automatically qualify for Medicaid in New Jersey—you don’t need to apply separately.

Medicaid Only

This program is for people who don’t get SSI but still meet the income, asset, and medical requirements for Medicaid. It’s for adults who are 65 or older, blind, or living with a disability, and need help paying for health care but don’t qualify for SSI.

New Jersey Care… Special Medicaid Program

This Medicaid program is for people in New Jersey who have low income and are 65 or older, blind, or living with a disability.

NJ WorkAbility

If you're a worker who has a disability and limited income and resources, the New Jersey Medicaid WorkAbility program can provide you with health care benefits. This program lets you work, keep more in your savings, and still get health care coverage. 

Medicaid Managed Long Term Services and Supports (MLTSS)

This NJ FamilyCare (Medicaid) program gives you health care and support services so you can stay in your own home and avoid having to move into a nursing home. You may take part in this program if you are age 65 or older or if you have a disability and are 21 to 64 years of age. You must also need help caring for yourself on a daily basis.

Medically Needy Medicaid

If your income is too high to qualify for other NJ FamilyCare ABD programs, but you have high medical expenses, you may be able to qualify through the Medically Needy Program (also called the Spend-Down Program). This option works by letting you spend down your income so that you meet the program’s income limits. The spend-down amount is the amount of income that is over the NJ FamilyCare ABD limit. This amount is different for each person.

To get NJ FamilyCare ABD benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get coverage for the rest of the calendar month. While using NJ FamilyCare ABD to pay for your medical expenses, you should use a health care provider who accepts Medicaid.

Some examples of medical expenses you can use to spend down your income include:

• Unpaid medical bills (that have not been used to spend down your income before)
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and NJ FamilyCare (Medicaid) work together?

NJ FamilyCare (Medicaid) pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from NJ FamilyCare. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full NJ FamilyCare coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the NJ FamilyCare program you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

If you have both Medicare and NJ FamilyCare, you should show both cards to your health care provider each time you receive services.

In addition, if you are dual-eligible for Medicare and NJ FamilyCare (Medicaid):

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for NJ FamilyCare?

When you apply for NJ FamilyCare, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for NJ FamilyCare ?

There are a few different ways you can apply for NJ FamilyCare. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for NJ FamilyCare is online through the NJ FamilyCare portal. All your personal information is kept 100% confidential and protected by special security technology. 

Apply through NJ FamilyCare portal

To apply for NJ FamilyCare in person, you can visit a County Social Services agency near you and fill out an application there. To complete an application over the phone, call DHS at 1-800-701-0710 (TTY: 711)  and complete the application with the help of a specialist.

DHS hours of operation are Monday and Thursday 8 a.m. - 8 p.m. and Tuesday, Wednesday, Friday 8 a.m. - 5 p.m. Live translators are available for most languages.

How can I get help with my application?

• Call DHS at 1-800-701-0710 (TTY: 711).
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559