Millions of low-income Americans receive basic health coverage through Medicaid, the nationwide health insurance program that was created in 1965. Medicaid is jointly funded by federal and state governments, and in New Jersey, Medicaid is administered through the NJ FamilyCare program under the Department of Human Services, Division of Medical Assistance and Health Services.
As of 1995, New Jersey shifted Medicaid beneficiaries from the previous fee-for-service program to managed care through five health plans in order to expand services and benefits.
Seniors aged 65 and older who are permanent New Jersey residents may qualify for free NJ FamilyCare coverage if they meet the following criteria:
- Have a total monthly income of $2,313 or less when applying as an individual or under $4,426 when applying as a couple
- Own less than $2,000 worth of countable assets as an individual or less than $3,000 when applying as a couple (principal residence valued at less than $878,000 excluded)
In New Jersey, residents who receive Social Security Income payments are automatically enrolled in the NJ FamilyCare program.
Countable assets include:
- Cash
- Bank account balances
- Stocks and bonds
- Real estate, including out-of-state properties
Asset exemptions include one vehicle, household furnishings, jewelry and a non-revocable burial trust.
Note: New Jersey has a 5-year look-back period for all Medicaid applicants and audits any assets that the applicant gave away, sold or otherwise liquidated during the 60-month period prior to applying for Medicaid. Penalties under the look-back program may include a period of ineligibility for Medicaid coverage that is determined by dividing the total value of the excess assets by the average monthly cost for private nursing home care.
Seniors who are otherwise excluded from Medicaid coverage in New Jersey due to excess income or assets may qualify for Medicaid services under the
Medically Needy Segment. This program allows seniors to subtract some medical costs from their monthly income in order to reduce their Medicaid-assessed income enough to qualify for NJ FamilyCare enrollment.
New Jersey seniors who are Medicaid-eligible are automatically enrolled in the
Medicaid Managed Long Term Services and Supports (MLTSS) program, which recently replaced HCBC waivers in the state. This program gives seniors access to all NJ FamilyCare
Plan A Benefits as well as a wide range of services, including care management, mental health and assisted living.
For assistance with a New Jersey Medicaid application, contact NJ FamilyCare at (800) 701-0710 or the
State Health Insurance Assistance Program (SHIP) at (800) 792-8820.