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New Jersey Medicaid, also called NJ FamilyCare, is the state’s implementation of the federal Medicaid program. This initiative provides healthcare for low-income families and individuals, as well as benefits for seniors or people with disabilities.
All residents of New Jersey can apply based on income level, as can individuals over the age of 65, blind, or disabled.
With New Jersey Medicaid, also known as NJ FamilyCare, you may be able to receive quality healthcare for little or no monthly premium or doctor’s bill. To prevent shouldering the debt of unexpected medical expenses, many New Jerseyans have the option to extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
The publicly funded program provides free or affordable healthcare to eligible low-income children, adults, pregnant women, and aged, blind, or disabled people. You deserve quality healthcare without having to risk your financial security. The guide below discusses everything you should know about New Jersey’s program, from applying through coverage.
New Jersey Medicaid consists of the NJ FamilyCare program for children, adults, and pregnant women, as well as NJ FamilyCare Aged, Blind, Disabled programs. New Jersey’s Department of Human Services administers the program, providing identical coverage for different demographics.
How is NJ Medicaid funded? The government funds these programs with a mix of federal and state funds.
Is New Jersey FamilyCare free? Most people won’t pay anything for NJ FamilyCare, but if you have a higher income, you’ll likely pay based on a sliding scale. Still, NJ FamilyCare provides the following enrollment statistics:
The Health Benefits Identification card under the NJ FamilyCare program requires enrolled individuals to use the card to prove they’re eligible to receive care under the Medicaid program. You receive the card in the mail after the state accepts your enrollment. The program will activate and deactivate the card based on your year-to-year eligibility.
You receive a second card (example only shown above) based on the particular managed care organization you enroll in. For example, third-party insurance providers may manage your health plan for you. You’ll need to bring both cards with you whenever you seek medical care or other covered services.
The New Jersey DHS strongly encourages you to apply online for NJ FamilyCare. It’s the fastest option and saves the state from mounting paperwork and administrative efforts. If you need help or have questions about the Medicaid application New Jersey residents have to go through, you can always call the toll-free number: 1-800-701-0710.
To apply in person, search for any of the enrollment sites.
You cannot apply through mail or over the phone in New Jersey.
Who is eligible for NJ Medicaid? Any New Jersey resident and qualified immigrant can receive benefits if they meet certain income and asset restrictions. The New Jersey Medicaid program bases its income limits on age and family size compared to the Federal Poverty Level. The limits are as follows:
Are you an immigrant wondering if you can obtain coverage? In general, pregnant women and young adults of age 19 and 20 can receive coverage if their income qualifies and they are “lawfully present” within the country, who may include:
The state mails your Health Benefits Identification card when you’re accepted into the program, and it functions as a permanent card throughout your period of coverage. If you lose eligibility, keep the HBID card in case you qualify in the future.
If you lose your card, call 1-877-414-9251 for a replacement.
The state never requires you to renew your card as they handle the activation and deactivation. If you lose NJ Medicaid eligibility and become eligible after two years or more, the New Jersey Department of Human Services automatically mails you a new card once you’re accepted again.
With New Jersey Medicaid, you can get access to top-quality healthcare services without the financial burden. The state’s Medicaid program comes with a wide variety of coverage options, ensuring that people in need receive the same level of treatment as those who can afford to pay for healthcare plans. New Jersey Medicaid ensures that the following services are available and low, or no cost to eligible members:
NJ FamilyCare covers a variety of dental services, including the following:
Understandably, some procedures require authorization before they can continue.
While New Jersey Medicaid has extensive dental coverage, there are yearly maximums. For those who have serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in New Jersey is advisable.
While your copayment for prescription drugs might differ depending on Managed Healthcare Organization enrollments or the type of medication you require, most people enjoy a ‘no copay’ status.
Your specific New Jersey Medicaid plan may cover all your medications or charge a maximum copay amount. Search for your medication to determine whether it’s covered under your plan.
The state also maintains the following programs to help reduce drug costs:
NJ Medicaid’s FamilyCare program provides special programs or coverage for individuals with special needs, such as:
If you're traveling out of state, check with your specific managed care organization to determine whether you will retain coverage for any medical procedures you may require. Most MCOs cover emergency medical care out of state, provided you show your HBID card.
However, if you require non-emergency care outside New Jersey, you must coordinate the care through your Primary Care Physician prior to receiving the service. No MCO covers medical care received outside the United States or its territories. If you are traveling outside of New Jersey for leisure, invest in proper travelers insurance.
New Jersey Medicaid doesn’t make any special provisions for explicitly covering students. However, students may still qualify for coverage based on their age or parent’s incomes.
Additionally, seniors have several options for NJ FamilyCare services, including the NJ Medicaid Managed Long Term Services and Support program. MLTSS provides the following for seniors:
Individuals who require a high level of care in a nursing home facility could receive full coverage for their short or long-term stay in a facility.
Because New Jersey FamilyCare has a low threshold for eligibility, they offer no special coverage for subgroups, such as indigenous people or veterans. Instead, members of these demographic populations should reach out to Indian Health Services or the US Department of Veterans Affairs for additional healthcare benefits and programs.
While NJ FamilyCare provides a wide variety of coverage, several procedures, services, and products do not fall under their program, including the following:
Once you enroll, your managed care organization can give you more information about what they cover in New Jersey and the limitations they impose.
It is also important to note that New Jersey Medicaid provides some assistance for funeral and burial costs. For eligible members, the States will provide up to $2,246 in funeral and $524 in burial fees. Considering the rising cost of funerals, ensure that your family is secured with comprehensive funeral insurance.
Navigating what NJ Medicaid covers can be overwhelming, even for people who work in the medical field. Even though NJ FamilyCare covers a wide variety of services and medical products, they often place restrictions on who, how often, and under what conditions they can receive these services.
Below is a list of the most common services people seek coverage for and whether these issues might be eligible for subsidy under New Jersey Medicaid.
| Dental | |
|---|---|
| Exams | Yes, twice a year. |
| Cleanings | Yes, included in exam. |
| Fluoride treatment | Yes, included in exam. |
| X-rays | Yes, included in exam (if medically necessary). |
| Wisdom teeth | Yes, under the program's maxillofacial surgical services. However, these procedures require prior authorization, depending on the age of the patient or the severity of their impaction. |
| Vision | |
|---|---|
| Eye Exams | Yes, once a year. |
| Glasses | Yes, every two years. |
| Laser Eye Surgery | No, however if your ophthalmologist deems such a procedure medically necessary and can use non-experimental methods, they may have cause to petition your case for coverage. |
| Surgery | |
|---|---|
| Rhinoplasty | A medically necessary rhinoplasty will often include a deviated septum, cleft palate, injury, or trauma. However, New Jersey Medicaid will not cover purely cosmetic rhinoplasties. |
| Breast Reduction | NJ FamilyCare currently covers gender reassignment surgery for people diagnosed with gender dysphoria, which can include a breast reduction. Your provider likely must request authorization prior to performing the procedure. |
| Hospital | |
|---|---|
| Hospital stays | The program covers inpatient hospital stays at critical access hospitals, rehabilitation facilities, and mental health emergency wards. Covered services during the inpatient stay should include the following in New Jersey: semi-private room accommodations, doctor services, anesthesia, lab, x-rays, and diagnostic services, medications, therapeutic services, nursing, routine products and procedures. |
| Ambulance transportation | Yes, for medical emergencies (land and air). New Jersey Medicaid sometimes covers non-emergency ambulance transportation with prior authorization (and when requested by your healthcare provider). |
| Giving birth | Yes, it covers maternal and newborn health services, including doulas, hospital stays, and medical care for the infant. |
After you apply for NJ Medicaid, you can receive the following covered mental health services:
| Sexual Health | |
|---|---|
| Gynecologist visits |
New Jersey Medicaid covers the following gynecological services and procedures:
|
| Erectile Dysfunction | No |
| Birth Control | Yes, the program offers a variety of family planning procedures and products, including pregnancy tests, prescription and over-the-counter birth control medications, tubal ligations, and long-acting reversible contraception, like IUDs and implants. |
| Fertility Treatment | No |
| Specialist Services | Sometimes, you need more medical attention than your primary care physician can provide. Here are the most common specialists and what NJ FamilyCare covers from them: |
|---|---|
| Dermatology | While NJ FamilyCare doesn’t explicitly cover dermatology, they cover medically necessary procedures such as diagnosis and treatment of skin cancer. |
| Physiotherapy | New Jersey Medicaid covers physical therapy in certain situations, such as for individuals under 21 on the Autism spectrum. They also cover generalized outpatient rehabilitation for up to 60 days per calendar year. |
| Massage Therapy | NJ FamilyCare does not cover massage therapy but does subsidize acupuncture treatment for anesthesiological purposes with a qualified doctor. |
| Podiatry and Foot Care | New Jersey Medicaid covers routine podiatry exams and medically necessary services. They also cover therapeutic shoes and inserts for patients with severe diabetes. Routine hygienic care, such as treating corns and calluses, only receives coverage when associated with a separate condition. |
| Allergy Testing | The NJ Medicaid FamilyCare plan makes no mention of allergy testing. However, it may cover it if you’re experiencing medically significant symptoms. They do cover allergy injections and over-the-counter and prescription allergy medications. |
| Sleep Physician Services and CPAP Machines | New Jersey Medicaid does not explicitly cover sleep therapy or CPAP machines. |
To speak with a NJ Medicaid representative for more details concerning your coverage, call 1-800-701-0710.
At Insurdinary, our goal is to make finding the best healthcare less overwhelming. On our website, you can compare the price of New Jersey Medicaid with other third parties or private insurance companies, including the managed care organizations that you’d work with through NJ Family Care. You can use private insurance providers to fill the gaps in your New Jersey Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Each New Jersey County provides access to at least four of the following managed care organizations:
If you want high-quality healthcare that won’t break the bank, Insurdinary can help you move beyond the basics of NJ Medicaid. Visit our website to get free quotes from the best providers in your area.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
