Income-Based Medicaid

Is It Right for You?

Medicaid, also called NJ FamilyCare, is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low income, no matter how much you have in resources or whether you have a disability. Income-based Medicaid is explained on this page.
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Medicaid coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability. Learn more about disability-based Medicaid.
• Have a disability and work, even if your income is higher. Learn more about Medicaid's NJ WorkAbility program.

Answer the questions on this page to see if you might qualify for income-based Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on GetCoveredNJ.

Do You Meet Income-Based Medicaid’s Basic Requirements?

To qualify for income-based Medicaid, you must:

• Be under 65 years old
  • You can be 65 or older if you are the parent or caretaker of a child.
• Not qualify for Medicare
  • You can be on Medicare if you are the parent or caretaker of a child or are pregnant.
• Be a U.S. citizen or meet specific noncitizen requirements

If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Medicaid might cover you.

Medicaid’s rules for immigrants:

• Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
• Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

Is Your Income Low Enough for Income-Based Medicaid?

These are the main income rules for income-based Medicaid:

• If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
• If you are 18 or younger and your family’s income is at or under 200% of FPG ($62,400 per year for a family of four), you may qualify and won't have to pay a monthly premium.
• If you are 18 or younger and your family’s income is between 200% and 355% of FPG ($110,760 per year for a family of four), you may qualify if you pay a monthly premium.
• If you are pregnant and your family’s income is at or under 205% of FPG ($63,960 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Medicaid, sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits, growth of the investments in an ABLE account, and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

Note: There are no limits to how much money or other resources you can have for income-based Medicaid.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,060
	$5,380
	$15,060
	$5,380
Income-based Medicaid, adults (138% FPG)
NJ FamilyCare, children, free (200% FPG)
NJ FamilyCare, children, premium (355% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Note: Some types of income do not count against these limits, including SSI benefits. Note: Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG).

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If your income is low enough and you meet all other requirements, you should sign up for Medicaid.

More Ways to Qualify for Medicaid if You Have a Disability

There are other ways to qualify for Medicaid if you have a disability. You might qualify for disability-based Medicaid if:

• You get Supplemental Security Income (SSI) benefits.
• You make more money at work than income-based Medicaid allows. In that case, you could apply for Medicaid's New Jersey WorkAbility program.
• You also get Medicare. Usually, Medicaid doesn’t cover people getting Medicare, but disability-based Medicaid does. It may even help pay your monthly Medicare premiums.
• You are 65 years old or older.

You might qualify for income-based Medicaid, even though you have a disability, if:

• Your disability does not meet Social Security’s definition of disability. Disability-based Medicaid is only for people who have disabilities meeting this standard.
• You have more resources than are allowed by disability-based Medicaid.
• You make enough money that you would have to pay a monthly premium for NJ WorkAbility.

Learn more about disability-based Medicaid and NJ WorkAbility.

How to Sign Up

Before you apply, NJHelps lets you get an anonymous estimate of whether you qualify for Medicaid or other state and federal programs.

You can apply for Medicaid:

• Online using NJ FamilyCare Quickstart, or
• At an outreach and enrollment site in your county.

NJ FamilyCare lists the information and documents you may need when you apply. For help with your application, talk with a Health Benefits Coordinator at 1-800-701-0710 or 1-800-701-0720 (TTY).

Staying on Medicaid

Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county social services agency know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Medicaid or if you have new health coverage options, like individual coverage with subsidies or NJ WorkAbility.