Medicaid Eligibility

Medicaid (also called NJ FamilyCare) helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services.

If you get Supplemental Security Income (SSI) benefits or used to get SSI benefits and now qualify for SSI's 1619(b) status, you get Medicaid coverage automatically and do not need to worry about the eligibility information discussed here.

If you don't get SSI benefits, Medicaid's eligibility rules depend on whether you are:

You can apply for Medicaid:

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).

Medicaid if You Are 18 or Younger

If you are 18 or under, you may qualify for Medicaid if:

  1. Your family has low income, regardless of whether you have a disability, or
  2. You have a disability and low resources and your family has low income (this way of qualifying is called "disability-based Medicaid").

Income-Based Medicaid

Whether or not you have a disability, when you apply for Medicaid, Medicaid will first check to see if you qualify for health coverage based on your household's Modified Adjusted Gross Income (MAGI).

If you are 18 or younger and your family’s income is 355% of the Federal Poverty Guidelines (FPG) or less ($91,413 per year or less for a family of four), you may qualify for Medicaid (NJ FamilyCare). It doesn't matter how much your family has in resources.

If your family's income is below 200% of FPG, there's no monthly premium for Medicaid coverage. If it's between 200% and 355% of FPG, there is a premium.

Check if your family's income is low enough for you to get Medicaid coverage and if you have to pay a premium:

Health Coverage Income Limits for Your Family

Disability-Based Medicaid

If you don't qualify for income-based Medicaid and don't get SSI benefits, Medicaid checks to see if you qualify for disability-based Medicaid. The eligibility rules for disability-based Medicaid are much more complicated than for income-based Medicaid.

To qualify, you must:

Because your countable income isn't the same as your total income, speak with a Benefits Planner to get an idea of whether you qualify for disability-based Medicaid.

Getting Medicaid coverage through SSI 1619(b)

If you get SSI, but then stop getting SSI benefits because your earned income goes up, a rule called 1619(b) lets you keep your automatic disability-based Medicaid coverage. With 1619(b), you can make up to $35,520 per year without losing your Medicaid.

1619(b) means that you can get Medicaid while earning way more than the program’s normal income limit, but your resources have to stay below SSI’s $2,000 resource limit. If your resources go over that limit, look into Medicaid's New Jersey WorkAbility program, which has a $7,730 resource limit.

Learn more about NJ WorkAbility.

Medicaid if You Are 19 or Older

If you are 19 or older, you may qualify for Medicaid if:

  1. Your family has low income, regardless of whether you have a disability, or
  2. You have a disability and low resources and your family has low income (this way of qualifying is called "disability-based Medicaid").

If you have a disability, work, and earn too much for Medicaid, you may qualify for NJ WorkAbility instead.

Income-Based Medicaid

If you are 19 or older and your household's Modified Adjusted Gross Income (MAGI) is 138% of FPG or less ($17,236 per year or less if you are single), you may qualify for income-based Medicaid (also called "MAGI Medicaid"). It doesn't matter how much your family has in resources.

If you are pregnant, you can have income up to 205% FPG ($34,666 per year if you are single and pregnant with your first child; the baby counts as a family member according to Medicaid).

Check whether your income is low enough for you to get income-based Medicaid:

Health Coverage Income Limits for Your Family
Is the adult income limit for income-based Medicaid 133% or 138% of FPG?

You may see the income limit for income-based Medicaid listed as 133% of the Federal Poverty Guidelines (FPG) in some places. However, when Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say that you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get Medicaid.

Learn more about income-based Medicaid for adults in DB101's How Health Benefits Work article.

Disability-Based Medicaid

If you don't qualify for income-based Medicaid, Medicaid checks to see if you qualify for disability-based Medicaid. To qualify, you must:

  • Have a disability that meets the Social Security Administration's adult definition of disability.
  • Have less than $4,000 in resources if you are single ($6,000 for couples). Some resources don’t count towards disability-based Medicaid’s resource limit, like the home you live in and one car.
  • Have less than $1,041 per month in countable income if you're single ($1,409 for couples).
    • Most SSI income rules, such as the Student Earned Income Exclusion (SEIE) for students under the age of 22, also apply to Medicaid.
    • If you are living with others, some of their income may be counted when your application is reviewed for disability-based Medicaid.

You can use DB101's Benefits and Work Calculator to see whether you qualify for Medicaid. If you live alone, get a quick estimate of your countable income for disability-based Medicaid:

Your Countable Income:

If you currently have disability-based Medicaid coverage and your income or resources go up, you may be able to switch to income-based Medicaid or to NJ WorkAbility.

Learn more about disability-based Medicaid for adults in DB101's How Health Benefits Work article.

Individual plans on Healthcare.gov

If you don’t qualify for Medicaid or NJ WorkAbility, look into other health coverage options on Healthcare.gov. Learn more about private health insurance.