New Jersey Medicaid, also known as the New Jersey Family Care program, is a health care program for those in financial need, funded by the federal government and the NJ state government. It's different from New Jersey Medicare. Let’s take a look at NJ Family Care eligibility and what the program covers.
In New Jersey, Medicaid covers one out of every seven adults (ages 19-64), one out of every three children, four out of every seven nursing home residents, and two out of every five people with disabilities. Contrary to popular belief, 53% of those NJ Medicaid beneficiaries are employed (but living in or close to poverty). New Jersey Family Care is a wonderful program for those who need it.
In general, New Jersey Medicaid coverage includes:
Depending on the health plan you choose, you can also get coverage for dental, vision, hearing, mental health, prescription drugs, medical equipment, chiropractic services, and more.
New Jersey Family Care, really branded as New Jersey FamilyCare, is the official name for NJ Medicaid. You may hear the names used interchangeably.
Once you enroll in NJ Family Care, you’ll have to select a plan based on what is available in your county. Medicaid plans in New Jersey are hosted by Aetna Better Health of New Jersey, Amerigroup (Anthem), Horizon Blue Cross Blue Shield of New Jersey, UnitedHealthcare Community Plan, and WellCare, all of which include a dental benefit.
Since you will choose a NJ Family Care plan from five carrier options, you’ll need to visit your carrier’s website for a provider search tool. Once there, you should be able to look for doctors, hospitals, and specialists in your area that accept your Medicaid health plan.
There are five different levels of NJ Family Care eligibility: A, B, C, D, and ABP (Alternative Benefit Plan).
You will fall into a plan based on your household income level and where you stand with the Federal Poverty Level (FPL):
Plan A: 0 to 142% of the FPL
Plan B: 142% to 150% of the FPL
Plan C: 150% to 200% of the FPL
Plan D: 200% to 350% of the FPL
Plan ABP: Less than 133% of the FPL, aged 19-64, no kids
Social Security benefits in New Jersey fall under the Division of Developmental Disabilities. If you qualify for Supplemental Security Income or DAC status (Disabled Adult Child), you most likely qualify for Medicaid as well.
The New Jersey WorkAbility program was created in 1999 as a result of the “Ticket to Work/Work Incentives Improvement Act of 1999.” It allows you to receive New Jersey Medicaid benefits even if you are not eligible for Medicaid because you are disabled and working.
You can qualify if you are between the ages of 16 and 64, have a permanent disability, are employed, and have not earned more than $60,625 annually (or $81,425 for a married and doubly disabled couple). You must also not make more than $981 per month in pensions, child support, or interest and you cannot have more than $20,000 in liquid assets (or $30,000 for an eligible couple).
Kids can meet NJ Family Care eligibility if the household income is at or below 350% of the Federal Poverty Level. Alternatively, there are two programs for kids who do not quite qualify for FamilyCare. Medicaid Special is for those under 21 whose household income is below 133% of the Federal Poverty Line but have “aged out” of Medicaid. Medically Needy NJ Medicaid is for those under 21 whose family makes too much money to qualify for Medicaid but whose medical expenses put them within the Medicaid eligibility limits. If you are unsure whether or not you or your child is eligible, call NJ FamilyCare at 1-800-701-0710 or contact your local County Board of Social Services.
Whether you qualify for Medicaid or not, everyone in New Jersey is eligible for the Prescription Assistance Program. You can save up to 75% on your prescriptions just for downloading the Pharmacy Discount Card! There are over 60,000 participating pharmacies in the state of New Jersey, which include various Walgreens, Kmart, CVS, Walmart, Target, and other grocery store locations. There’s no reason you shouldn’t sign up for the NJ Prescription Assistance Program now!
Going hand-in-hand with the NJ Prescription Assistance Program is PAAD, the Pharmaceutical Assistance to the Aged & Disabled program. You can qualify for NJ PAAD if you are a New Jersey resident who is either over 65 or receiving Social Security Title II Disability benefits and you earn less than $27,189 if you’re single or $33,334 if you are married. To start with PAAD, you will need a Medicare Part D prescription drug plan. PAAD will help cover your Part D premium and your copayments will be reduced to $5 for generic drugs and $7 for brand-name drugs.
When you apply for PAAD, you’ll also be applying for the other programs that are part of the “NJ Save” program. This includes Medicare Savings Programs, hearing aid assistance, Extra Help, utility payment assistance, and more.
In general, there are quite a few ways for you to save money on prescription drugs in New Jersey. The Express Savings Pharmacy, located in Sicklerville, accepts Medicaid and most other insurance, plus offers up to 40% off on most prescriptions. They also have free prescription delivery, next-day fulfillment, and free blood pressure monitoring, counseling, advice, and brochures. They even have a kid-friendly waiting room with refreshments.
If you haven’t chosen a pharmacy in your area yet, you can use the New Jersey Divison of Consumer Affairs website to search for NJ drug prices. They have supplied a list of the 150 most prescribed drugs. Click on the drug that you received a prescription for, enter your zip code, and find the pharmacy in your area that offers the best price.
If you live in either Atlantic County or Bergen County, there are County Wellness Discount Programs specific to your area. Atlantic County residents can save an average of 24% on prescription drugs by enrolling in the Atlantic County Prescription Discount Program. Bergen County residents can save on prescriptions, vision services, and hearing aids by signing up for the Bergen County wellness discount program.
The best way to apply for New Jersey Medicaid is to do so online. You’ll click the button that says “Start New Application” (or “Resume Existing Application” if you’ve already begun) and click through the steps. By submitting your application online, you won’t miss any steps. However, if you prefer, you can download the New Jersey Medicaid Application here, fill it out, and send it to the address listed on the seventh page.
To complete your New Jersey Medicaid Application, you will need proof of your identity, age, citizenship, marital status, New Jersey residency, ownership, and income. These are some examples of items that you can use:
If you need help completing the New Jersey Medicaid Application, visit njfamilycare.org, call 1-800-701-0710, or visit your local County Board of Social Services.
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