New Jersey Medicaid Plan for Family, Low Income - NJ FamilyCare

NJ FamilyCare

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Zip Code08701
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Program Details

What is NJ FamilyCare?

NJ FamilyCare - New Jersey's publicly funded health insurance program - includes CHIP, Medicaid and Medicaid expansion populations. That means qualified NJ residents of any age may be eligible for free or low cost health insurance that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services and even hospitalization.

Who is it for?

Medicaid,Family, Low Income

Who is Eligible?

NJ FamilyCare includes: children, pregnant women, parents/caretaker relatives, single adults and childless couples. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.
Children 18 and under are eligible with higher incomes up to 355% FPL ($7,189/month for a family of four). Parents still need to renew the coverage each year. Children age 18 and under who are lawfully admitted can be eligible even if they have lived in this country fewer than five years.
Parents/Caretaker Relatives with income up to 138% FPL ($2,795/month for a family of four) must have tax dependent children in their household in order to be eligible under this category. The dependent children in the household must be insured also. Immigrant adults must have Legal Permanent Resident status in the US for at least five years in order to be eligible for NJ FamilyCare.
Adults without dependent children with ages 19-64 and income up to 138% FPL ($1,367/month for a single person and $1,843/month for a couple). Immigrant adults must have Legal Permanent Resident status in the US for at least five years in order to be eligible for NJ FamilyCare.
Pregnant Women up to 205% FPL ($4,152/month for a family of four). Pregnant women who are lawfully admitted can be eligible even if they have lived in this country fewer than five years.
Aged, Blind, Disabled programs including Long Term Care.

What is Covered?

Doctor visits, Eyeglasses, Hospitalization, Lab tests, X-rays, Prescriptions, Regular check-ups, Mental health, Dental, Preventive screenings. In addition to a number of other wide range services

How much is it?

$0 or minimal share of cost

How to Apply?

There are several ways you can apply:
We strongly encourage you toApply Online. If you need help, call toll free 1-800-701-0710 and a Health Benefits Coordinator will help you.
If you prefer to have face to face assistance, click on theNeed Help Enrollinglink of this web site and select your county to find a list of agencies in your area that can help. Choose a site that offers personal assistance and they will be able to help you apply.
You can also click on theApplylink of this website to download the application and mail it to: PO Box 8367, Trenton, NJ 08650

How is the NJ FamilyCare health plan appeal process changing?

Beginning July 1, 2017, the New Jersey Managed Care Organization appeal process for denials of health care services will be different because of changes to the federal rules that the managed care health plans must follow. The managed care health plans and the State know the new rules. You should know that, if you request an appeal or Medicaid Fair Hearing for health care services on or after July 1, 2017, your health plan will guide you through the process.

What does it mean that I have to renew my insurance every 12 months?

Renewal is simply a way of checking to see if anything has changed in your family's situation. You may be sent a preprinted form to confirm your household size, or you may be sent a blank application to fill out. It is very important that you respond to any written request so your insurance coverage will not be lost or interrupted.

Is it true that I must be without health insurance for 3 months before I can be eligible for NJ FamilyCare?

Yes, this is true. However, there are exceptions to this rule, such as if you lost your insurance because your place of work went out of business or you were laid off. Depending on income, other exceptions may apply for families privately paying for health insurance or for COBRA benefits. We strongly urge you to call 1-800-701-0710 and speak with a Health Benefits Coordinator to find out if any exceptions apply to you.

I have a job out of state. The health insurance I receive is not accessible to my family. Will they qualify for NJ FamilyCare in spite of the fact that I have insurance?

Yes, if your health insurance is not accessible to your family, they may be eligible for NJ FamilyCare.

I am a single adult. Can I qualify for the NJ FamilyCare program?

All adults age 19-64 with income up to 138% of the Federal Poverty Level should apply for NJ FamilyCare. Immigrant adults must have Legal Permanent Resident status in the US for at least five years in order to be eligible. Pregnant women do not need to have Legal Permanent Resident status.

If I am an adult without dependent children and had a prior criminal offense which was classified as a felony or crime involving the possession, use, or distribution of a controlled substance, can I still get childless adult Medicaid coverage?

Prior to January 1, 2014: The Division does not directly consider any prior offense involving possession, use, or distribution of controlled substances in a Medicaid eligibility determination; however, currently, being eligible for Work First New Jersey/General Assistance (WFNJ/GA) is a requirement to become eligible for childless adult Medicaid coverage. The WFNJ/GA eligibility rules provide that if an adult without dependent children has a conviction that involves possession or use of a controlled substance, that person can become eligible for WFNJ/GA only if they enroll in and complete a licensed residential drug treatment program and undergo drug testing during the treatment program and for 60 days thereafter. A failed drug test will cause WFNJ/GA benefits to terminate, and this would affect Medicaid eligibility. The WFNJ/GA eligibility rules also provide that if an adult without dependent children was convicted of distribution of a controlled substance, the person cannot ever qualify for WFNJ/GA.
Beginning January 1, 2014: Federal rules permit states to offer Medicaid eligibility to adults without dependent children, outside of the WFNJ/GA program. Therefore, prior drug convictions for possession, use or distribution of controlled substances will no longer be a factor in Medicaid eligibility.

How long do I have to live in the United States before I can be eligible for NJ FamilyCare?

Children age 18 and under and pregnant women who are lawfully admitted can be eligible even if they have lived in this country fewer than five years. Immigrant adults must have Legal Permanent Resident status in the US for at least five years in order to be eligible for NJ FamilyCare.

I don't speak English very well, and I am afraid to call.

NJ FamilyCare's 800 number is linked with a translation service. Whatever your native language is, we will arrange to have a third person on the line who can speak your language. They will be there to interpret for you and the Health Benefits Coordinator. Don't be afraid! Call 1-800-701-0710!

Can I apply at my County Welfare Agency?

Yes, you can. Actually, if your income is low at this time, it would be a very good idea to apply at a County Welfare Agency. There is a possibility that you might be eligible for other programs, such as food stamps. The representatives at the County Welfare Agency will be able to help you. You can find your County Welfare Agency's address and telephone number by going to " Need help enrolling?" and click on your county of residence. They will be listed there.

I cannot make up my mind as to which Health Plan to select. What should I do?

First you should check out the list ofNJ FamilyCare Health Plans, and see which are available in your County. Then you should contact your family doctor to see if he or she is participating in one of those Health Plans - be sure to specify NJ FamilyCare when you ask. If your doctor does not participate in an NJ FamilyCare Health Plan, we recommend that you call 1-800-701-0710 to have one of our Health Benefits Coordinators assist you. Select a Health Plan even if you are not sure. Not choosing a Health Plan will SLOW DOWN your application process. Once your family members are enrolled in NJ FamilyCare, you will have an opportunity to change your Health Plan at a later date, if you are not satisfied.

If I have to pay a monthly premium, how important is it to send in my check once I receive a notice?

It is very important that you send in your payment as soon as you know your monthly premium. You will receive notice of your premium by mail. New members cannot be enrolled or use their health benefits until the full payment has been received. Once enrolled you will be billed monthly. You must pay in full and on time in order to continue health coverage.

Can I keep the same doctor I have now?

Yes, if your doctor participates in one of the Health Plans providing services for NJ FamilyCare in that county. Call your doctor and ask if he or she is providing services for NJ FamilyCare and if so, under which HMO. Then choose that HMO as your Health Plan.

I have lost my job and can no longer afford the premiums for NJ FamilyCare. Is there anything I can do to maintain coverage?

You can call 1-800-701-0710 and request a status review. Your family's eligibility status will then be reevaluated based on current income, and could result in your paying a lower premium or no premium. Until your status review is complete, it is important to continue to pay your premium in full and on time each month.

What if my family makes too much money to qualify for NJ FamilyCare?

NJ residents at higher income levels can purchase health insurance through the Federal Health Insurance Marketplace

What if I'm pregnant?

NJ FamilyCare covers low income pregnant women too!Apply onlineor visit your local County Welfare Agency. Contact the respective local County Welfare Agencyin your area.
Pregnant women already enrolled in NJ FamilyCare should contact 1-800-701-0710 and advise them of your pregnancy. NJ FamilyCare wants to be sure you are receiving all of the benefits that your pregnancy entitles you to.

If I enroll in the new expanded NJ FamilyCare program, when I die and try to leave something to my kids, can the government put a lien on my assets to repay the benefits I received?

In the case of an NJ FamilyCare beneficiary who became deceased on or after April 1, 1995 for whom payments for services were made on or after October 1, 1993, a lien may be filed against and recovery sought from the estate of the deceased recipient for assistance correctly paid or to be paid on his or her behalf for all services received when he or she was 55 years of age or older. There are some exceptions. See Estate Recovery-What You Should Know.

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  • Phone Number
    (732) 367-7171
  • Office Locations
    LAKEWOOD, NJ 08701

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