How to Fill Out and Submit the NJ FamilyCare Appeal Form

To challenge a denial, reduction, or termination of NJ FamilyCare coverage, submit the NJ FamilyCare appeal form — a written Fair Hearing Request — to the Division of Medical Assistance and Health Services within 20 calendar days of the date on your notice.¹ File within 10 days and you can also ask that your current benefits stay in place while the case is decided.² You do not need a lawyer, and the hearing itself is free.

Where to Get the Form

The Fair Hearing Request form is usually mailed to you along with the written notice from DMAHS or your managed care organization telling you that coverage is being denied, reduced, or ended. If you never received one or lost the original, you have two other options. Check the DMAHS section of the New Jersey Department of Human Services website (nj.gov/humanservices) for a downloadable copy, or use the template request letter published by Disability Rights New Jersey, which covers the same required information.

You are not locked into the state’s pre-printed form. Any clear written request that includes the necessary details will be accepted. Using the official form simply reduces the risk of leaving something out.

What to Put on the Form

The form is one page, but every field connects your appeal to the right case file. Fill in each of the following:

Your full name and home address, exactly as they appear on your NJ FamilyCare notice. If you moved since your last renewal, list both the old and new address so the Fair Hearing Unit can find your file.
Your date of birth and a phone number where you can be reached during business hours. The hearing office uses these to contact you about scheduling.
The date on the notice you received. Copy it exactly from the top of the letter. This date starts the 20-day clock.
How the notice reached you — mail, phone, email, fax, or another method. This can matter if there is later a dispute about when your deadline began.
A brief written explanation of why you disagree with the decision. Plain language is fine. For example: “My income has not changed and I still qualify,” or “My doctor says I need this treatment and it should be covered.”
A check in the box requesting that your current benefits continue during the appeal, if you are an existing member facing a cut or termination. See the section below before deciding.
An interpreter request, if you need the hearing conducted in a language other than English. Specify the language.

Also copy over your NJ FamilyCare member ID number and any case or notice reference number printed on the adverse-action letter. Those numbers speed up processing and keep the Fair Hearing Unit from having to hunt down your file by hand.

How to Submit the Form

You can file by mail or fax. The mailing address is:

Division of Medical Assistance and Health Services
Fair Hearing Unit
P.O. Box 712
Trenton, NJ 08625-0712

If you mail it, send it certified with a return receipt. That receipt is your proof that the state received your request on time. The alternative is fax, at (609) 588-2435, which is faster and generates a transmission confirmation page you should keep. When the deadline is close, fax is the safer choice.

The 20-Day Deadline

Your request must reach DMAHS within 20 calendar days from the date printed on the notice.¹ Count from the date on the notice itself, not from the day the envelope arrived and not from the postmark. Several of your 20 days may already be gone by the time you open the letter. Miss the window, and you lose the right to appeal that decision.

Keeping Your Benefits While the Appeal Is Pending

If you already have NJ FamilyCare and the state is cutting or ending your coverage, you can ask that your existing benefits continue unchanged until the appeal is decided. To qualify, file the hearing request within 10 days of the date on the notice of action.² That is half the time you get for the appeal itself, so act quickly if you rely on ongoing treatment, prescriptions, or specialist visits.

This protection is only for people who already had benefits. It does not apply to first-time applicants who were denied coverage. There is also a financial risk: if the judge ultimately rules against you, the state can seek to recover the cost of services you received during the appeal period.² For most people who genuinely believe they still qualify, preserving coverage is worth that risk, particularly when the alternative is going without medication or doctor visits for months.

What Happens After You File

Once the Fair Hearing Unit has your request, DMAHS transmits the case to the New Jersey Office of Administrative Law for scheduling. Expect two letters. First, a confirmation from DMAHS that your request has been forwarded. Then, roughly two to three weeks later, a hearing notice from the OAL with the date, time, and location.

Hearings can be held in person at an OAL courtroom or conducted remotely by phone or video.³ If you need to reschedule, contact the OAL as early as you can. Adjournments are granted more readily when the request comes early rather than the day before.

Before the hearing, request your case file from the county welfare agency or managed care organization. You have the right to examine everything in it, and errors — an income figure from the wrong month, a household member counted incorrectly, a medical record that was never reviewed — are more common than you might think. Bring copies of documents that support your case: recent pay stubs, tax returns, bank statements, a letter from your doctor, or proof that you submitted paperwork the state claims it never received.

Getting Help

You can represent yourself, and many people do. If you would rather have help, Legal Services of New Jersey handles NJ FamilyCare appeals and can assist with preparing evidence, understanding the eligibility rules, and representing you at the hearing. Call the statewide LSNJ LAWLine at 1-888-576-5529 to find out whether you qualify for free assistance.⁴ Your county’s local legal aid office is another route, and many have staff who specialize in Medicaid cases and have appeared before OAL judges many times before.

New Jersey also allows representation by a non-attorney in certain circumstances, such as a legal services paralegal.⁵ For DMAHS cases, that person applies to appear by certifying they are not a disbarred attorney and are not charging a fee, and the judge decides whether to allow it.⁶

1
Legal Information Institute. New Jersey Administrative Code 10:49-10.3 – Opportunity for Fair Hearing
2
Legal Information Institute. New Jersey Administrative Code 10:49-10.4 – Advance Notice of Intent to Terminate, Reduce, or Suspend Assistance for Medicaid and NJ FamilyCare-Plan A Beneficiaries
3
Legal Services of New Jersey. Types of Cases Heard in the Office of Administrative Law
4
Legal Services of New Jersey. LSNJ Statewide Hotline
5
Legal Information Institute. New Jersey Administrative Code 1:10-5.1 – Representation at Hearing
6
Legal Information Institute. New Jersey Administrative Code 1:1-5.4 – Representation by Non-Lawyers; Authorized Situations, Applications, Approval Procedures