New Jersey Medicaid: Eligibility, Benefits, and How to Apply

New Jersey Medicaid, known in the state as NJ FamilyCare, provides free or low-cost health coverage to residents whose income falls below category-specific limits: most adults up to 138% of the federal poverty level, children up to 355% FPL, and pregnant women up to 205% FPL, with separate income and asset rules for people who are 65 or older, blind, or disabled.¹ The program covers doctor visits, hospital care, prescriptions, mental health treatment, maternity care, adult dental services, and long-term care, and you can apply online, by mail, or at your county board of social services.

Who Qualifies

You must live in New Jersey and be a U.S. citizen or hold a qualifying immigration status. A state ID or a recent utility bill usually satisfies the residency requirement. People visiting the state temporarily are not covered.

Legal permanent residents who entered the United States on or after August 22, 1996, generally wait five years before qualifying for full Medicaid benefits.² That waiting period does not apply to refugees, asylees, Cuban and Haitian entrants, certain Amerasian immigrants, or veterans and their spouses. Children under 19 qualify regardless of immigration status.¹

NJ FamilyCare sorts applicants into four groups: children under 19, adults 19 to 64 (including parents, caretaker relatives, single adults, and childless couples), pregnant women, and people who are aged, blind, or disabled. Each group has its own income rules.

Income Limits for 2026

For most applicants, eligibility is based on Modified Adjusted Gross Income (MAGI), which uses federal tax rules to compare household income to the federal poverty level.¹ The 2026 FPL for a single person in the contiguous United States is $15,960 per year, or $1,330 per month; for a family of four it’s $33,000 per year, or $2,750 per month.³

The 2026 monthly income ceilings work out to:

Adults 19 to 64 (138% FPL): $1,836 for an individual, $2,489 for a couple.
Children under 19 (355% FPL): $9,763 for a family of four.
Pregnant women (205% FPL): $5,638 for a family of four. Coverage extends through pregnancy and 12 months postpartum.

These figures come from the NJ FamilyCare eligibility page.¹

Under MAGI, savings accounts, property, and other assets don’t count. Only income does. The one big exception is the Aged, Blind, and Disabled category.

Rules for Seniors and People with Disabilities

If you’re 65 or older, blind, or disabled, you must meet both an income limit and an asset limit. For 2026, the resource cap is $2,000 for an individual and $3,000 for a couple.⁴ Bank accounts, cash, stocks, and bonds count against that limit. A primary residence, one vehicle, personal belongings, and up to $1,500 in burial funds do not.

Income limits depend on the specific program. The Medicaid-Only program, for people who don’t receive Supplemental Security Income, uses 100% FPL, or $1,330 a month for an individual in 2026.⁵ If you’re clinically eligible for nursing-facility-level care, the ceiling rises to $2,982 a month, which equals 300% of the federal SSI benefit rate.⁴

Medicare Savings Programs

New Jersey also offers programs that help pay Medicare premiums and cost-sharing for people with limited income. All three use 2026 income standards:⁵

Qualified Medicare Beneficiary (QMB): income up to $1,330 a month for an individual (100% FPL).
Specified Low-Income Medicare Beneficiary (SLMB): up to $1,596 (120% FPL).
Qualifying Individual (QI-1): up to $1,796 (135% FPL).

Extra Rules for Long-Term Care

Applying for Medicaid-funded nursing home care or home-based long-term services triggers financial rules that go beyond the standard tests. Three catch people off guard.

The Five-Year Look-Back

When you apply for long-term care, the state reviews every asset transfer you made during the 60 months before your application. Any transfer for less than fair market value during that window — giving a house to a child for $1, say — can trigger a penalty period during which Medicaid won’t pay for your care.⁶ The penalty length is the value of what was transferred divided by the average monthly cost of nursing home care in New Jersey.

Spousal Impoverishment Protections

When one spouse enters a nursing home and the other stays home, federal law protects the at-home spouse from being wiped out. The community spouse can keep a share of the couple’s combined assets called the Community Spouse Resource Allowance. For 2026, the federal minimum is $32,532 and the maximum is $162,660.⁷

The community spouse is also entitled to a Monthly Maintenance Needs Allowance drawn from the institutionalized spouse’s income. For 2026, the federal maximum is $4,066.50 per month, and the minimum is $2,643.75.⁷ If the community spouse’s own income falls below that floor, they can draw from the institutionalized spouse’s income to reach it.

Qualified Income Trusts

If your income exceeds the $2,982 monthly ceiling for nursing-facility-level care but you still can’t afford to pay privately, a Qualified Income Trust (sometimes called a Miller Trust) may help you qualify.⁸ The trust receives all of your income, and the trustee distributes it under Medicaid rules — paying toward your care, the community spouse’s allowance, and a small personal-needs allowance. Whatever remains at your death goes to the state to reimburse Medicaid. Setting one up typically requires an elder law attorney.

What NJ FamilyCare Covers

Federal law requires state Medicaid programs to include a set of mandatory benefits, and New Jersey adds several optional ones.⁹ Covered services include primary and preventive care, specialist visits, inpatient and outpatient hospital care, emergency room visits, mental health and substance use treatment, prescription drugs, lab work and imaging, and maternity care.

Adult dental coverage is broader in New Jersey than in most states. It includes exams and cleanings twice a year, x-rays, fillings, crowns, root canals, periodontal treatment, extractions, and complete and partial dentures.¹⁰ Crowns and dentures require prior approval. Cosmetic work is excluded.

Most enrollees pay nothing out of pocket. Higher-income families with children may face small sliding-scale copayments. The vast majority of members have no monthly premium.

Choosing a Managed Care Plan

After you’re approved, you pick a managed care organization to coordinate your services. Five participate:¹¹

Aetna
Fidelis Care
Horizon
UnitedHealthcare Community Plan
Wellpoint

Not every plan operates in every county. If your current doctors are in one of these networks, picking that plan lets you keep them. Call the Health Benefits Coordinator at 1-800-701-0710 to compare options.¹¹ If you don’t choose within the enrollment window, the state assigns one.

How to Apply

Gather these documents first:¹²

Social Security numbers for everyone in the household. You can still apply if a member doesn’t have one.
Proof of income: recent pay stubs, W-2s, or your most recent federal tax return.
Proof of residency: a New Jersey driver’s license, state ID, or a recent utility bill.
Immigration documents, if applicable.
Employer insurance details, if anyone in the household has access to employer-sponsored coverage.

You can submit the application three ways. Applying online through the NJ FamilyCare portal at njfamilycare.dhs.state.nj.us generates an instant confirmation number that proves your filing date.¹³ You can also mail the paper application to the centralized processing office in Trenton, or visit your local County Board of Social Services in person.

Count your household carefully: include everyone who lives together and shares finances. Report gross monthly income, before taxes and deductions.

Processing Time

Applications currently take 30 to 45 days.¹⁴ During that window, state workers verify what you submitted. You’ll get a written notice confirming enrollment or asking for more documents. If more information is requested, respond immediately — the notice includes a deadline, and missing it can lead to a denial. Once approved, you receive a health benefit ID card and can start using covered services.

Retroactive Coverage

Medicaid can pay medical bills you incurred before you applied. Under current federal law, coverage can be applied retroactively for up to three months before your application month, as long as you met all eligibility requirements during that time. Starting in January 2027, the Budget Reconciliation Act of 2025 shortens that window to two months for people 65 and older or with disabilities, and one month for expansion adults under 65. If you have unpaid medical bills from recent months, apply as soon as you can.

Renewing Your Coverage

NJ FamilyCare renews once a year.¹⁵ The state sends a packet before your anniversary. Some renewals go through automatically using electronic data; when the state can’t confirm eligibility that way, you have to respond with updated information. Missing the deadline creates a coverage gap that can take weeks to fix. Keep your address and phone number current so renewal notices reach you.

Appealing a Denial or Reduction

If NJ FamilyCare denies your application, cuts your benefits, or ends your coverage, you can challenge that decision. The process runs in stages.

First, file an internal appeal with your managed care plan. If that doesn’t go your way, you can request a state Medicaid Fair Hearing. You have 120 calendar days from the date on your internal appeal denial letter to make that request.¹⁶ The state must issue a final decision within 90 days of receiving the request.¹⁷

If you’re already receiving services being reduced or cut off, you can ask to keep them while the appeal is pending. But you have to request that continuation within 10 calendar days of the denial letter from your health plan, or before the end of the prior authorization period, whichever is later.¹⁶ That 10-day window is tight. If you lose the final appeal, the state or MCO may bill you for the cost of services provided during the appeal period.¹⁸

Estate Recovery After Death

Families often don’t learn about this part of Medicaid until it’s too late. Federal law requires New Jersey to seek repayment from the estates of deceased beneficiaries who were 55 or older when they received covered services.⁶ Recovery covers all Medicaid payments made on the person’s behalf, including managed care capitation payments for months when no service was actually used.¹⁹

Recovery is postponed when there is a surviving spouse, or a surviving child who is under 21, blind, or permanently disabled. It resumes once the surviving spouse dies or the child turns 21 or is no longer disabled.¹⁹

The state also declines to pursue recovery in three situations: when the cost of recovery would exceed what would be collected; when the estate property is the only income source for survivors and pursuing it would push them onto public assistance; and when a family member lived in the beneficiary’s home before death and still lives there. In that third case, the state may place a lien but won’t enforce it until the property is sold or the family member dies or moves out.¹⁹ Medicare cost-sharing payments made by Medicaid under the Medicare Savings Programs are not subject to estate recovery.

1
NJ FamilyCare. Who Is Eligible
2
Office of the Law Revision Counsel. 8 USC 1613 – Five-Year Limited Eligibility of Qualified Aliens for Federal Means-Tested Public Benefit
3
HHS ASPE. 2026 Poverty Guidelines
4
New Jersey Department of Human Services. New Jersey FamilyCare Aged, Blind, Disabled Programs
5
New Jersey Department of Human Services. Income Eligibility Standards Effective January 1, 2026
6
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
7
Medicaid.gov. 2026 SSI, Spousal Impoverishment, and Medicare Savings Program Resource Standards
8
Social Security Administration. SSI Federal Payment Amounts
9
Medicaid.gov. Mandatory and Optional Medicaid Benefits
10
New Jersey Department of Human Services. NJ FamilyCare Dental Services for Adults
11
NJ FamilyCare. Choosing a Health Plan
12
NJ FamilyCare. Applicant NJFC Application Check List
13
NJ FamilyCare. Apply for NJ FamilyCare
14
New Jersey Department of Human Services. Cover All Kids – Apply for NJ FamilyCare
15
New Jersey Department of Human Services. Stay Covered NJ – Members: Make Sure You Renew
16
NJ FamilyCare. The NJ FamilyCare Health Plan Appeal Process
17
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries
18
eCFR. 42 CFR 438.420 – Continuation of Benefits While the MCO Appeal and the State Fair Hearing Are Pending
19
New Jersey Department of Human Services. The New Jersey Medicaid Program and Estate Recovery – What You Should Know