A Guide to New Jersey Medicaid - NJ Family Care

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.

    What Is New Jersey Medicaid?

    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:

    • Over 2,284,000 individuals currently receive coverage from the program.
    • 97.1% of enrollees partner with a managed care organization.
    • Over 65% of enrollees identify as part of the long-term care population (in-home and community-based services).
    • Nearly 25% of New Jersey’s population receives coverage from a NJ FamilyCare plan.

    What Is a NJ FamilyCare Card?

    New Jersey Medicaid

    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.

    Applying for NJ FamilyCare

    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.

    Eligibility Requirements

    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:

    • Children under the age of 19, regardless of immigration status, qualify for coverage with an income up to 355% of the Federal Poverty Levels.
    • Adults between the ages of 19 and 64 can receive coverage with an income up to 138% of the Federal Poverty Level.
    • Pregnant individuals qualify for the program with an income up to 205% of the Federal Poverty Limit.
    • Anyone over the age of 65 or who is blind or disabled can determine their eligibility by sending information to the state via mail. The state will then establish whether the person qualifies for benefits.

    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:

    • A lawful permanent resident
    • Refugees and asylees
    • Cuban-Haitian entrants
    • An undocumented resident with a deportation delayed by USCIS
    • An Amerasian immigrant
    • A child of an honorably discharged military veteran
    • Certain Canadian-born American Indians
    • An immigrant with at least a year-long parole
    • An applicant under the Violence Against Women Act

    Getting a NJ Medicaid Card

    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.

    Renewing or Replacing Your HBID Card

    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.

    NJ Medicaid Coverage

    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:

    • Doctor’s visits
    • Prescription eyeglasses
    • Hospital stays
    • Lab tests like blood draws
    • X-rays and diagnostic imaging
    • Prescription medication
    • Routine checkups
    • Mental health treatment and diagnosis
    • Non-cosmetic dental care
    • Preventive screenings
    • Autism services
    • Community doula services
    • Help with personal care needs


    NJ FamilyCare covers a variety of dental services, including the following:

    • Diagnostic procedures
    • Preventive practices
    • Restorative intervention
    • Endodontic (specialist) treatment
    • Periodontal (gums) procedures
    • Oral and maxillofacial (jaw) surgery

    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.

    Prescription Drugs

    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:

    • Pharmaceutical Assistance to the Aged and Disabled: New Jersey residents over the age of 65 or those disabled and aged between 18 and 64 can apply for Medicaid NJ programs like PAAD. The program pays any copay over a certain amount for generic drugs.
    • Senior Gold Prescription Discount: As an expansion of the PAAD program, SGPD covers seniors with higher incomes. Members pay a copay plus 50% of the remaining cost of any drug.
    • Aids Drug Distribution Program: The ADDP provides HIV and AIDs medication for enrolled individuals. To qualify in New Jersey, your income can’t exceed 500% of the Federal Poverty Level.

    Extended Health Care

    NJ Medicaid’s FamilyCare program provides special programs or coverage for individuals with special needs, such as:

    • Alzheimer’s Adult Day Services: The AADS subsidizes day care services for adults with Alzheimer’s or related dementia. The program covers between 20% and 100% of the cost for up to five days each week. Care centers that contract through the AADS provide a minimum five-hour program each day, one full meal, activities tailored to the participant’s interests, necessary transportation, and family support.
    • Statewide Respite Care Program: SRCP provides short-term relief for family members caring for an ailing or disabled person within their home. Based on the caregiver’s income, the program provides up to 25% of the cost and temporary care, which can allow the caregiver to take a vacation, seek medical services, or run errands. To qualify, the caregiver must be attending to an adult at least 18 years of age who doesn’t live in a specialized facility and requires daily attention.
    • Congregate Housing Services Program: The CHSP provides services to people with disabilities in subsidized housing. The program provides at least one meal every day and, depending on the building, may offer housekeeping, shopping, laundry, meal preparation, and personal care services. Recipients must live in a facility that contracts with the CHSP.
    • Community Choice: This program works with seniors, people with disabilities, and their families to educate them on long-term care options. Within the program, registered nurses and social workers meet with residents in nursing homes and hospitals to assess their required level of care, provide information about in-home services, and explain eligibility for various medical assistance programs.
    • Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.

    Travel and Out-of-State Coverage

    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.

    Students & Seniors

    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:

    • Enrollment into NJ FamilyCare Plan A
    • Managed long-term care
    • Necessary modifications to their home and vehicle
    • Meals delivered to the home
    • Respite services
    • Personal Emergency Response Systems
    • Services for mental health and addiction treatment
    • Subsidies for assisted living
    • Services for long-term care within their home
    • Subsidies for nursing home care

    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.

    Coverage for Subgroups

    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.

    What NJ FamilyCare Does Not Cover

    While NJ FamilyCare provides a wide variety of coverage, several procedures, services, and products do not fall under their program, including the following:

    Any services deemed not medically necessary
    Any service covered under a third-party program or non-Medicaid government benefit
    Unnecessary cosmetic services, such as breast reductions
    Experimental procedures or those without proven efficacy
    Treatment for infertility
    Respite care exceeding 30 days each year
    Items not directly related to patient care, including guest meals or phone charges
    Services provided by a federal institution, such as the Veterans Health Administration
    Procedures provided without charge or through public or volunteer agencies
    Treatment resulting from work-related injuries or accidents when workers’ compensation benefits or temporary disability applies

    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.

    Common Procedures and NJ FamilyCare Eligibility

    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.

    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.
    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.
    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 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.
    Therapy and Counselling

    After you apply for NJ Medicaid, you can receive the following covered mental health services:

    • Adult rehabilitation at a supervised facility (for Plan A and ABP members only)
    • Inpatient psychiatric treatment
    • Independent psychologist, psychiatrist, or advanced practice nurse services
    • Outpatient mental health treatment
    • Partial care (with prior authorization) up to five hours per day, five days per week
    • Psychiatric emergency services
    • Medically managed inpatient withdrawal and detoxification after substance abuse
    • Opioid treatment services
    • Substance use disorder treatment of various durations
    Sexual Health
    Gynecologist visits

    New Jersey Medicaid covers the following gynecological services and procedures:

    • One baseline mammogram for women between 35-39 years old and a yearly mammogram for women at least 40 years old
    • Pap smears and pelvic exams every twelve months
    • Routine gynecological exams, preventive treatments, and medically necessary 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.

    Extending NJ FamilyCare Coverage

    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:

    • United Healthcare Community Plan and WellCare: All 21 counties in New Jersey have access to this managed care organization, and they highlight their 24/7 nurse advice line and member services.
    • Horizon NJ Health: This organization is also available in all 21 counties and maintains one of the largest provider networks in New Jersey with over 20,000 doctors.
    • Amerigroup New Jersey, Inc: Available in all 21 counties, Amerigroup boasts a 24-hour nurse helpline, extra support for expecting and new mothers, and free online resources to find food, jobs, housing, and legal advice.
    • Aetna Better Health of New Jersey: Universally available throughout New Jersey, Aetna sets itself apart by offering extensive rewards programs for well-child visits, mammograms, lead screening, and postpartum care.
    • Fidelis Care: You can obtain coverage from Fidelis Care in every New Jersey county except Hunterdon. They offer several rewards programs, and you don’t need a referral to visit an in-network specialist.

    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.


    How long does it take to get approved for New Jersey Medicaid?

    The approval timeline for New Jersey Medicaid varies based on individual circumstances, typically taking around 45 days on average. Urgent cases may be expedited for quicker processing.

    What are the methods to apply for New Jersey Medicaid?

    Apply for New Jersey Medicaid online, in person, by mail, or at a local Department of Human Services office. Ensure you submit necessary documents like proof of income, household size, and residency with your application.

    Does New Jersey Medicaid cover funeral expenses?

    No, New Jersey Medicaid primarily offers healthcare coverage and does not include benefits for funeral expenses. Explore options like funeral insurance for assistance with those costs.

    Who is eligible for New Jersey Medicaid?

    Eligibility for New Jersey Medicaid is determined by factors such as income, household composition, and other considerations. The program typically extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is New Jersey Medicaid?

    New Jersey Medicaid is a program designed to provide medical coverage to eligible low-income residents of the state. Funded jointly by federal and state resources, its goal is to ensure access to essential healthcare services for those who qualify.

    What other types of insurance does Insurdinary offer?

    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:


    1. https://njfamilycare.dhs.state.nj.us/who_eligbl.aspx
    2. https://njfamilycare.dhs.state.nj.us/analytics/home.html
    3. https://dmahs-nj.my.site.com/familycare
    4. https://njfamilycare.dhs.state.nj.us/need_help.aspx
    5. https://www.nj.gov/humanservices/dmahs/clients/medicaid/abd/ABD_Checklist_NJFC-ABD-CL-0416.pdf
    6. https://njfamilycare.dhs.state.nj.us/imm_info.aspx
    7. https://www.libertydentalplan.com/Resources/Documents/NJ_FamilyCare_Dental_Benefits_Grid.pdf
    8. https://www.optumrx.com/oe_rxexternal/prescription-drug-list?type=ClientFormulary&var=ACNJ&infoid=ACNJ&page=insert&par=
    9. https://nj.gov/humanservices/doas/services/paad/
    10. https://nj.gov/humanservices/doas/home/seniorgolddetail.html
    11. https://www.nj.gov/health/hivstdtb/hiv-aids/medications.shtml
    12. https://nj.gov/humanservices/doas/services/aads/
    13. http://www.state.nj.us/humanservices/doas/home/aadspfacilities.html
    14. https://nj.gov/humanservices/doas/services/srcp/
    15. https://nj.gov/humanservices/doas/services/chsp/
    16. https://nj.gov/humanservices/doas/services/choice/
    17. https://www.nj.gov/humanservices/dmahs/home/mltss.html
    18. https://www.ihs.gov/forpatients/
    19. https://www.va.gov/health-care/
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