Medicaid in NJ

New Jersey Medicaid Info

New Jersey MedicaidNew Jersey Medicaid is a government health insurance program available to people with very limited income and resources. Medicaid in New Jersey does not pay money to you. It sends payments directly to your health care providers.

Medicaid in NJ can pay for medical services in your own home or if you live in a residential care facility that takes Medicaid residents.

Medicaid in New Jersey provides health insurance to parents/caretakers and dependant children, pregnant women, and people who are aged, blind or disabled. These programs pay for hospital services, doctor visits, prescriptions, nursing home care and other healthcare needs, depending on what program a person is eligible for.

 To be eligible for New Jersey Medicaid, a person must:

  • be a resident of New Jersey
  • be a U.S. Citizen or qualified alient (most immigrants who arrive after August 22, 1996 are barred from Medicaid for five years, but not from NJ FamilyCare and certain programs for pregnant women)
  • meet specific standards for financial income and resources

Medicaid in New Jersey will pay for assisted living and homebased care under medicaid waiver programs and other New Jersey state programs.

Medicare is different from Medicaid. Medicare 2017 Rates and supplement insurance

Costs for assisted living run 4-7,500 per month.

You need to demonstrate the need for nursing home care ( not being able to manage in a home environment, requiring assistance with activity of daily living skills for more than 2.5 hours per day) and you need to meet the strict financial requirements established by the state.

New Jersey expanded Medicaid in accordance with the ACA, utilizing federal funding to provide health insurance for the newly-eligible population starting in 2014.

As a result, New Jersey’s total Medicaid enrollment increased by nearly 20 percent (250,553 people) between the fall of 2013 and June 2014.  In that same time frame, the state’s uninsured rate was cut nearly in half, falling from 21.2 percent to 11.5 percent.

Who is eligible for Medicaid in NJ?

In addition to the aged, blind, and disabled, the following New Jersey residents are eligible for Medicaid:

Adults with incomes up to 138 percent of poverty
Children with household incomes up to 350 percent of poverty are eligible for CHIP in New Jersey.  This is one of the most generous thresholds in the country.
Pregnant women with incomes up to 200 percent of poverty (unchanged from 2013).

How do you apply?

In New Jersey, all Medicaid coverage – including previously eligible populations as well as the population that is newly-eligible under the Medicaid expansion guidelines – is handled by NJ Family Care.

Medicaid enrollment is available year-round.  Applicants can apply for Medicaid via, or through the NJ Family Care online application.

The NJ Family Care website also has paper applications that can be downloaded, although they strongly encourage online applications.  They can be reached by phone at 1-800-701-0710 if applicants need assistance.

NJ Medicaid Spend Down

What is spenddown in Medicaid?

NJ Medicaid spenddown is similar to a deductibe in insurance

Under the “spend down” process, some states allow you to become eligible for Medicaid as “medically needy” even if you have too much income to qualify. This process allows you to “spend down” or subtract your medical expenses (like the cost of hospital care or doctor’s visits) from your income to become Medicaid eligible.

Subtracting medical expenses from income can reduce your income to a level below the maximum allowed by your state’s Medicaid program. In order to be eligible as “medically needy,” your countable resources (savings accounts, certifi cate of deposits, etc.) also have to be under the established resource standard in your state. About Health Insurance