As part of a regular process each year, NJ FamilyCare income eligibility levels are updated based on increases in the federal poverty guidelines that are announced in January.

Even though New Jersey does not publish the income eligibility levels until late February, they are effective retroactively to January 1 of that year. This means that if you were denied or terminated from NJ FamilyCare in January or February for being slightly over the income limit, that determination may have been incorrect because it was based on outdated income limits for the prior year. You can appeal (if you are within the time limit to do so) or file a new application, asking that your eligibility be reconsidered under the updated 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

ACA Medicaid Expansion is the program for adults ages 19 to 64. The central eligibility criterion is having income at or below 138% of the federal poverty level (FPL). The FPL increases and is updated every year. The only other eligibility criteria are not being enrolled in Medicare and certain immigration-related restrictions. People who qualify for this program pay no premiums or cost-sharing. An up-to-date listing of the eligibility limits for different household sizes can be found at NJ FamilyCare's Who is Eligible? page.

Child coverage through Medicaid and CHIP

Many NJ FamilyCare programs 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.

Children in families with income up to 355% FPL are eligible for a NJ FamilyCare CHIP program. At the moment, CHIP premiums have been suspended by the state, but parents may have to pay co-pays ranging from $5 to $35. As of January 1, 2023, immigration status is not considered for children under the age of 19. All children are eligible for NJ FamilyCare coverage if their family income is under the eligibility limit.

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 “New Jersey Care” ABD program for persons with income up to 100% FPL. 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.

Bottom line

If you are denied or terminated from any NJ FamilyCare program, make sure that the agency is using the current 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. If you think you were denied or terminated in error, contact the LSNJ Health Care Access Project through the LSNJLAW^SM Hotline at www.lsnjlawhotline.org (1-888-LSNJ-LAW, 1-888-576-5529), or your local Legal Services program.

This information last reviewed: Dec 26, 2024