Medicaid Eligibility in New Jersey

Eligibility Team
Researcher & Writer
December 12, 2017

New  Jersey Medicaid is a program that was designed specifically to assist  individuals and families who have a low income get the healthcare they  need.

New Jersey’s Requirements for Medicaid Qualification

Eligibility for Medicaid in New Jersey is dependent mainly on the  income of the family or individual who is applying. Only those families  and individuals who have incomes that are within the allotted range will  be able to receive benefits. New Jersey also has a few other  requirements for eligibility. These are that you are a citizen of the US  and a resident of New Jersey, have a valid Social Security number, and  more. You have to meet every single one of the requirements in order to  be accepted into the Medicaid program in New Jersey.

Other requirements include people who are:

  • Pregnant
  • Children
  • Low income
  • Over the age of 65 or are disabled and/or blind
  • Families who have children under the age of 18
  • Women who have no other insurance and suffer from breast or cervical cancer
  • Immigrants who are undocumented yet need emergency care

How to Apply for Medicaid in in New Jersey

If you feel you might be eligible for Medicaid, you are welcome to  start the process at any time. There are a few different ways to apply.  Once you have applied for benefits, you will need to wait a few weeks  for your paperwork to be processed by the state department.

Many people who apply for Medicaid in New Jersey are beginning to use  the online application. The first step in this process is to utilize  the screening tool the state used and that can be found at NJHelps.  That tool will assist you in determining if you will be able to qualify  for Medicaid and it will also tell you which documents you need to  provide when you apply. If you pass the tool, you can then download the New Jersey Medicaid Application.

Some people prefer to apply in person. You can do this by going to  the board of social services in your county. The addresses and phone  numbers (for those who wish to apply by phone) for those are found here.  When you get to the specified office for your county, one of their  qualified staff members will assist you with your application for  Medicaid in New Jersey by evaluating you for the different types of  Medicaid as well as for any other assistance programs that New Jersey  offers. Please note that you will need to have an appointment before you  go in.

What Does Medicaid Cover in New Jersey?

Coverage by Medicaid in New Jersey will include things like:

  • Mental health services that are provided in a doctor’s office, an approved mental health clinic, or a hospital
  • Medical services that are provided by a doctor in an office, clinic, or another medical facility
  • Prescription drugs obtained from a pharmacy – this also includes some types of over the counter medications
  • Home health services, nursing home care, medical day care, or a personal care assistant
  • Services from chiropractors, dentists, podiatrists, psychologists, and optometrists
  • Eyeglasses, hearing aids, artificial limbs, braces, and orthopedic shoes
  • Outpatient and inpatient hospital care, rehabilitation services and hospice care
  • Clinic services like speech, occupational, and physical therapies
  • Laboratory services, X-rays, and durable medical supplies and equipment
  • Transportation to any services that Medicaid covers

Income Requirements for New Jersey Medicaid

All of the requirements for Medicaid with regard to an individual or  family income are determined by the MAGI (Modified Adjusted Gross  Income). Adults have to have an income that is less than 138% of the FPL  (Federal Poverty Level). If you are a family with a pregnant member,  the income cannot be more than 200% of the FPL. If there are children in  the home, 350% of the FPL is the number to beat.

You can see the specific numbers of income levels and family or household members here.

How Much Does Medicaid Cost in New Jersey?

The estimated cost for New Jersey Medicaid is determined by the  beneficiary. Some of the medical services will be covered 100% while  others might be offered at a cost that is lower than what it typically  is. Some Medicaid recipients are exempt from any types of payment.  Examples of those who do not pay for any services are pregnant women and  children age 19 and under.

Cost and Coverage of Medicaid in New Jersey

When your application for Medicaid has been approved, you will  receive a letter in the mail that will give you the information  regarding the premium for your coverage. This cost will be determined by  a variety of factors that will include your family or household size,  income, how many people will need coverage, and more.

Prescription Drugs with Medicaid in New Jersey?

Prescription drugs are covered by Medicaid. You might have to get  generic instead of brand name if the formulary calls for it. These  medications will either be free or have a small copay.

Which Medicaid plan is best in New Jersey?

When you apply for Medicaid in New Jersey and get approved, you will  need to choose which health plan you will use. Each county in the state  has a minimum of three plans to choose from. Depending on where you are,  you might have options such as:

  • United Healthcare Community Plan and WellCare
  • Horizon NJ Health
  • AMERIGROUP New Jersey, Inc.
  • Aetna Better Health of New Jersey

No matter which health care plan you choose, it will have to be  renewed after each 12-month period. During the period of renewal, the  family and financial status of the applicant will need to be evaluated  for any changes. If you fail to renew, you might have a loss or  interruption of the coverage.

Eligibility Team
Written by
Eligibility Team
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