New Jersey FamilyCare
by Thomas D. Begley, Jr., Esquire, CELA and Emily M. Schurr, Esquire
What Is It?
New Jersey FamilyCare is a Medicaid program providing health insurance to approximately 20% of New Jersey residents. The program is funded through both federal and state dollars. It also provides coverage for individuals who qualify for the Children’s Health Insurance Program (CHIP). Eligibility is determined by income and family size.
What is Covered?
New Jersey FamilyCare covers a wide range of medical and support services, including:
- Doctor visits (note: not all doctors accept NJ FamilyCare)
- Hospitalizations
- Prescriptions
- Regular check-ups
- Mental health services
- Eyeglasses
- Dental care
- Lab tests
- X-rays
- Preventive screenings
- Autism services
- Community doula services
- Help with personal care needs
Eligibility
Eligibility is based on financial eligibility which varies depending on family size. Income is determined using the latest federal tax return. The family size includes parents or caretakers, all blood-related and tax-dependent children under age 21, as well as any other tax-dependent individuals living in the home. Individuals with lower income may receive a larger tax credit to help cover the cost of insurance.
Adults ages 19 to 64 are eligible with incomes up to 138% of the FPL.
Children under age 19 are eligible with family household incomes up to 355% of the federal poverty level (FPL). Children can qualify regardless of their immigration status.
Currently, NJ FamilyCare does not have a work requirement, however, this may change in the coming years for certain applicants.
Managed Care
Managed care is administered by insurance companies known as managed care organizations (MCOs). Providers in New Jersey currently include AETNA, Fidelis Care, Horizon, United Health Care Community Plan, and Wellpoint. All managed care insurance companies provide coverage in every New Jersey county, except Fidelis Care, which does not provide coverage in Hunterdon County.
Medicaid Estate Recovery
New Jersey FamilyCare is a Medicaid-funded program and, therefore, subject to estate recovery under the New Jersey Estate Recovery statute. Under federal and state law, New Jersey Medicaid, also known as the Division of Medical Assistance and Health Services (DMAHS), is required to recover funds from the estates of certain deceased Medicaid beneficiaries or former Medicaid beneficiaries for all payments made under the Medicaid program for services received on or after age 55.
An “estate” includes any property owned by the individual at the time of death, most commonly the home. The State will not pursue recovery while a surviving spouse is living or if the decedent leaves behind a child under age 21, or a child who is blind or permanently disabled. However, estate recovery is merely postponed—not waived—and typically resumes after the surviving spouse or qualifying child passes away. Medicaid liens are often placed on the home to secure this recovery.
Begley Law Group, P.C. has served the New Jersey and Philadelphia area for over 90 years. Our attorneys have expertise in the areas of Personal Injury Settlement Consulting, Special Needs Planning, Long-Term Care Planning, Estate Planning, Estate & Trust Administration, and Guardianship. Contact us today to begin the conversation.