NJ Medicaid Eligibility: Income Limits and How to Apply

Key Takeaways

• NJ Medicaid, administered as NJ FamilyCare, covers adults with household income up to 138% of the federal poverty level under ACA Medicaid expansion. This is approximately $20,783 annually for an individual.
• NJ FamilyCare IS NJ Medicaid. They are the same program. NJ FamilyCare encompasses Plans A through D, covering children, pregnant women, parents, and adults at varying income levels.
• Applications can be submitted online, by phone, in person at a county Board of Social Services, or with the help of staff at many addiction treatment facilities.
• Presumptive eligibility allows some individuals to begin receiving Medicaid-covered treatment before their full application is processed, reducing delays in accessing care.
• Income limits and eligibility criteria are subject to change. The figures cited in this guide reflect general thresholds and should be verified with NJ FamilyCare directly.

Understanding whether you qualify for NJ Medicaid — and how to apply — can make the difference between accessing addiction treatment and facing a financial barrier that delays care. New Jersey’s Medicaid program is more expansive than in many other states because the state accepted federal ACA Medicaid expansion. This guide covers eligibility requirements, the application process, and what to do if you need treatment while your application is pending.

NJ Medicaid Eligibility Requirements

NJ FamilyCare eligibility is based primarily on household income, household size, and categorical requirements (age, disability status, pregnancy, parenting status). New Jersey’s acceptance of ACA Medicaid expansion significantly broadened eligibility for adults.

Income Limits by Household Size

Under ACA Medicaid expansion, New Jersey covers adults ages 19 through 64 with modified adjusted gross income (MAGI) at or below 138% of the federal poverty level (FPL). The following table provides approximate annual income thresholds by household size based on federal poverty guidelines. These figures are approximate and subject to annual adjustment:

Household Size	Approximate Annual Income Limit (138% FPL)
1	$20,783
2	$28,208
3	$35,632
4	$43,056
5	$50,481
6	$57,905

Additional categories cover different populations at different income thresholds:

• Pregnant women: Income up to 200% FPL
• Children ages 0-5: Income up to 147% FPL for Plan A; higher income levels qualify for Plans B and C (up to 355% FPL)
• Children ages 6-18: Income up to 147% FPL for Plan A; higher income levels qualify for Plans B and C
• Parents and caretaker relatives: Various thresholds depending on household composition

Who Qualifies Under the ACA Expansion

New Jersey’s Medicaid expansion under the ACA, implemented in 2014, extended coverage to a population that was previously excluded from Medicaid in most states: adults ages 19 through 64 who are not pregnant, not disabled, and not parents of dependent children — but whose income falls below 138% FPL.

Before expansion, childless adults in New Jersey had extremely limited Medicaid eligibility. The expansion population includes:

• Single adults without dependents
• Adults without disabilities
• Individuals who are employed but have low wages and no employer-sponsored insurance
• Individuals who are between jobs or unemployed

This population is particularly relevant in the context of addiction treatment, as substance use disorder disproportionately affects individuals experiencing economic instability, job loss, and housing insecurity.

Definition Block — Modified Adjusted Gross Income (MAGI): The income calculation method used to determine Medicaid eligibility under the ACA. MAGI includes adjusted gross income plus tax-exempt interest, foreign income, and non-taxable Social Security benefits. It does not include Supplemental Security Income (SSI). For Medicaid purposes, MAGI is calculated before taxes and does not require an asset test.

NJ FamilyCare vs. Medicaid

One of the most common questions about NJ’s public insurance program is whether NJ FamilyCare and Medicaid are different things. They are not.

They Are the Same Program

NJ FamilyCare is the brand name New Jersey uses for its Medicaid and CHIP (Children’s Health Insurance Program) combined program. When a provider says they accept “NJ Medicaid” or “NJ FamilyCare,” they mean the same coverage. The NJ FamilyCare brand was adopted to make the program more approachable and to unify multiple coverage categories under a single identity.

All NJ FamilyCare plans cover substance use disorder treatment as an essential health benefit. Regardless of which plan (A, B, C, or D) a beneficiary is enrolled in, addiction treatment services are available.

Plan Options Under NJ FamilyCare

NJ FamilyCare includes multiple plan tiers:

• Plan A: No premium, no copays. Covers the lowest income populations, including expansion adults under 138% FPL.
• Plan B: No premium for children; small premium for adults in certain categories. Covers populations at slightly higher income levels.
• Plan C: Small monthly premium. Covers children in families with income up to 355% FPL.
• Plan D: No premium. Specifically for the ACA expansion adult population (ages 19-64, income up to 138% FPL).

Most adults seeking addiction treatment who qualify for NJ FamilyCare are enrolled in Plan A or Plan D, both of which have no premium and minimal to no cost-sharing for covered services.

How to Apply for NJ Medicaid

New Jersey offers multiple pathways for submitting a NJ FamilyCare application. The process is designed to be accessible regardless of computer access, English proficiency, or familiarity with government programs.

Online Application

The NJ FamilyCare online application is available at njfamilycare.dhs.state.nj.us. The online portal allows applicants to:

• Complete and submit the full application electronically
• Upload supporting documentation (proof of income, identity, residency)
• Check application status after submission
• Report changes in income or household composition

The online application takes approximately 20 to 30 minutes to complete and requires basic information about household members, income sources, and current insurance status.

Phone and In-Person Options

For individuals who prefer not to apply online or need assistance:

• By phone: Call the NJ FamilyCare Hotline at 1-800-701-0710. Representatives can walk applicants through the process and take applications over the phone. The hotline operates during standard business hours and offers multilingual assistance.
• In person: Every NJ county has a Board of Social Services office where residents can apply in person. Staff members assist with completing the application and collecting required documentation.
• By mail: Paper applications can be downloaded from the NJ FamilyCare website and mailed to the NJ FamilyCare Processing Center.

Getting Help from a Treatment Facility

Many addiction treatment facilities in New Jersey employ enrollment specialists or social workers who help patients apply for NJ FamilyCare as part of the intake process. This is a significant resource because:

• Treatment staff are experienced with the application process and common issues
• They can help gather required documentation
• They can initiate presumptive eligibility so treatment can begin immediately
• They can coordinate with the county Board of Social Services on the patient’s behalf

If cost is a barrier to treatment and you believe you may qualify for NJ FamilyCare, contacting a treatment provider directly and asking about enrollment assistance is a practical first step.

Checking Your Application Status

After submitting a NJ FamilyCare application, the review process typically takes between 30 and 45 days for a determination. During high-volume periods, processing may take longer.

Online Status Check

Applicants who applied online can check their application status through the NJ FamilyCare online portal. The portal provides real-time updates on where the application stands in the review process and whether any additional documentation is needed.

Applicants who submitted by phone, mail, or in person can call the NJ FamilyCare Hotline at 1-800-701-0710 to check status.

What to Do If Your Application Is Delayed

If processing is taking longer than expected or if you need treatment urgently:

• Ask about presumptive eligibility. If you are seeking treatment at a qualified provider, they may be able to activate temporary coverage while your application is being processed. Presumptive eligibility allows treatment to begin immediately based on a preliminary determination that you likely meet income requirements.
• Contact the county Board of Social Services. In-person follow-up at the county office can sometimes expedite cases that have stalled in processing.
• Request expedited processing for medical need. If a healthcare provider can document urgent medical need for treatment, this may support a request for accelerated processing.
• Explore state-funded treatment options. While waiting for Medicaid approval, NJ DMHAS-funded treatment programs serve uninsured residents. Contact 1-844-ReachNJ for referrals to state-funded programs.

Definition Block — Presumptive Eligibility: A temporary Medicaid eligibility status granted by a qualified healthcare provider based on a preliminary income determination. Presumptive eligibility allows individuals to receive covered services — including addiction treatment — while their full NJ FamilyCare application is being processed. The individual must submit a complete application during the presumptive eligibility period.

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This article is part of the complete guide to paying for rehab in New Jersey. For information about what Medicaid covers for addiction treatment, see the guide to NJ Medicaid coverage for rehab. For options available to uninsured residents, see the guide to rehab without insurance in NJ. For additional low-cost options, see the guide to free and low-cost rehab programs.

NJ Addiction Centers is an informational resource and is not a treatment provider. Eligibility criteria and income limits cited in this article are approximate and subject to annual federal adjustments. Contact NJ FamilyCare directly at 1-800-701-0710 for the most current eligibility information.