MEDICAID

Adults

General Assistance Eligibles may receive Medicaid

Note: This is a state-funded program.

Pregnant Women

Caretaker parents of children already enrolled in Medicaid

Uninsured single adults/couples without dependent children

Medical Emergency Payment Program for Aliens

Families/Children

Children under age 1

Children ages 1 through 6

Children ages 7 through 18

Children Ages 19 to 21, who do not qualify as dependents, whether or not they reside with their parents (including full-time students)

Income: See next column
Asset limit: $2,000

Income 185% of FPL or less.
No asset limit.

Earned income 133% of FPL or less.
No asset limit.

Income 50% of FPL or less
No asset limit.
Note: Applications in this category are no longer being accepted.

Must meet the same financial requirements as citizens for either Medicaid or S-CHIP eligibility.  Cannot qualify through GA.

Income 185% of FPL or less.
No asset test.

Income 133% of FPL or less.
No asset test.

Income 133% of FPL or less.
No asset test.

Medicaid Special Programs Income Limits
(see chart below)

Eligibility for Medicaid is determined by the Department of Social Services/Welfare at the county and municipal levels.

Eligibility for GA is also determined at county and municipal levels.  All TANF eligibility issues are handled by the counties (no municipalities).

General Assistance Monthly Income Limits:
Single Adults who are employable: $140
Single adults who are unemployable: $210
Childless couples who are employable: $193
Childless couples who are unemployable: $289
(Other criteria must also be met.)

A child born to a woman eligible for and receiving Medicaid is guaranteed eligibility for one year regardless of any change in circumstances, so long as the child continues to reside with the mother.

Some Medicaid and all CHIP (NJ FamilyCare) recipients are enrolled in one of four benefit plans, depending on eligibility category.  These benefit packages are called NJ FamilyCare Plans A, B, C and D.

For children under 21 who are not dependents, income for the household they are living in is considered for eligibility, whether or not they live with their parents.

Certain assets are exempt in determining Medicaid eligibility.  These include home and household effects, life insurance under $1,500 per person and one car valued at $4,500 or less.

Earned income disregard = $90/month.
Childcare deduction: up to $200/month.

General Assistance (GA) considerations:
§         GA recipients are automatically enrolled in Medicaid; when GA case closes, Medicaid ends
§         The fair market value of a car that exceeds $9,500 is treated as an asset (same as TANF).
§         If an individual quits his/her job, there is a 90-day waiting period for GA.

Pregnant women remain eligible through the month in which the 60th day beyond the end of pregnancy falls.

For the Medical Emergency Payment Program for Aliens, an application must be made after the emergency but within three months of the date of the emergency for that emergency to be covered.  Labor and delivery is considered an emergency.

TANF

Families with dependent children

If TANF qualifications are met, individual(s) may receive Medicaid benefits.

Income: See gross income limits (next column).

Asset limit: $2,000

Eligibility for TANF determined by Department of Social Services/Welfare Agencies at the county level.

Income disregard: $50 per month for child support.

Gross income limits by family size:
1 person: $243
2 people: $482
3 people: $636
4 people: $732

For recipients who own a car, the fair market value of a car above $9,500 is treated as a countable asset.  The fair market value of a second car up to $4,650 is excluded.

Welfare reform jobs program is called Work First New Jersey (WFNJ).  Eligibility for Medicaid is based on TANF eligibility regardless of participation in WFNJ.

Medically Needy

Aged, Blind or Permanently Disabled

Children Under Age 21

Pregnant Women

Income or financial assets are too high to qualify for regular Medicaid but a spend down provision allows documented medical expenses to be used to reduce monthly income to meet eligibility limits.

Same as above.

Same as above.

Asset limits for medically needy are as follows:
One person: $4,000
Two people: $6,000
$100 for each additional person.

Qualified adults are entitled to most Medicaid covered services except inpatient hospital care and prescription drugs.  Long-term care services are covered.

Qualified pregnant women receive most Medicaid covered services including inpatient hospital, prescription drugs, medical daycare, chiropractic, and podiatry.

Qualified children are entitled to most Medicaid covered services except inpatient hospital care.

Qualified aged, blind or disabled are entitled to most Medicaid covered services except inpatient hospital.  Podiatry and medical daycare are covered.

Elderly/Disabled

Institutional Medicaid (including long term care) for the aged, blind and permanently disabled

Aged, Blind and Disabled (ABD)
“New Jersey Care…Special Medicaid Program”

SLMB

Permanently disabled individuals ages 16-64 who are working

“New Jersey Work Ability” Program

Income < $1,635/month currently (changes annually).
Asset limit: $2,000 for one person, $3,000 for two people.

Must meet one of the following requirements:
§         Be SSI recipients (automatically eligible for Medicaid), or
§         Have income at or below 100% of FPL and assets of $4,000 or less for an individual and $6,000 for couples.
*Includes QMBs

Income 135% of FPL or less.
Asset limits: $4,000 for one person, $6,000 for two people

Earned income 250% of FPL or less plus earned income disregards
Unearned income 100% of FPL or less (Social Security and Railroad Retirement excluded)
Asset limits: $20,000 for an individual and $30,000 for a couple (IRAs and 401(k)’s are disregarded).

Applicants for institutional Medicaid are considered on an individual basis and the eligibility process is complex.  Once eligibility is established, full Medicaid coverage is provided.  However, the individual’s income must be used to offset the cost of institutional care.
Approved facilities include:
§         Acute care general hospitals,
§         Nursing facilities,
§         Intermediate care facilities for the mentally retarded, and
§         Psychiatric hospitals for persons under 21 and 65+

Working disabled individuals whose income is greater than 150% of FPL must pay a $25 monthly premium.

For QMB, Medicaid pays Medicare premiums, deductibles and coinsurance.
In addition, QMBs also receive full Medicaid coverage.

For SLMB, Medicaid pays Medicare Part B premium.
Note:  Individuals must apply for the PAAD program in order to qualify for SLMB. 

S-CHIP (NJ FamilyCare)

Parents/caretakers of children under age 19

Single adults/couples without dependent children

Pregnant Women

Children Under Age 19

Income 200% of FPL or less

Income 100% of FPL or less
NOTE: Applications in this category are no longer being accepted.

Gross income greater than 185% and less than or equal to 200% of FPL

Income 134% - 350% of FPL

There is no asset limit for CHIP (NJFamilyCare) applicants.

Children and adults must be uninsured and cannot have had coverage under another health plan for six months.  This requirement is waived if the child’s family income is less than 133% FPL (NJ FamilyCare Plan A) and the child was covered under an individual health care benefits plan or COBRA plan prior to application for NJ FamilyCare.
For those over 200% of FPL, there is a six-month waiting period if current insurance coverage (or COBRA coverage) is dropped involuntarily.

The six month-waiting period is waived if a child was not voluntarily disenrolled from an employer-sponsored group insurance plan during the six months prior to application for NJ FamilyCare, or the child loses insurance as a result of a job change and the insured person does not have access to affordable coverage in the new job.

A monthly premium is required of families with incomes over 150% of FPL as well as copayments.
No income disregards are included in the determination for cost sharing.  There is a limit of 5% cost sharing per family.

Family Size

Earned Income Standard

Unearned Income Standard

1

$982

$185

2

$1,324

$369

3

$1,665

$443

4

$2,007

$507

5

$2,348

$567

6

$2,689

$604

7

$3,031

$677

8

$3,372

$728

Each Additional Person

$50