MEDICAID

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Medicaid is a program that provides health coverage to some low-income New Jersey residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Other legal residents who are not U.S. citizens may be eligible for Medicaid if they have emergency needs.  Non-citizens who do not have immigration documents cannot enroll in Medicaid but may be eligible for other state funded programs, such as NJ Family Care, if lawfully admitted.

•·In New Jersey you may be eligible for Medicaid if you are an infant, a child, a pregnant woman, or a parent of a child, and your family income meets the Medicaid income standards.

  • Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact you local department of social services for more information.

Low-income persons eligible for Medicaid in New Jersey*

Category – Income eligibility (as percent of federal poverty level)
Infant  — 200% (monthly income of about $2,767 for a family of 3)
Child 1-5 — 133%
Child 6-19 – 133%
Non-working Parent – 100%
Working Parent — 100%
Pregnant woman — 200%
Medical Needy– Individual– 51%
      Couple– 45%
* Eligibility information was compiled from State Health Facts Online, Henry J. Kaiser amily Foundation and may have changed since this guide was published.  Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2006:

Size of Family Unit — Poverty Guideline (annual income)
               1                                             $  9,800
               2                                             $13,200
               3                                             $16,600
For larger families add $3,400 for each additional person
So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $34,200, or a monthly income of $2,767.

Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

  • Families who get cash benefits from Temporary Assistance for Needy families (TANF), which is also known as Work First New Jersey or WFNJ, can get Medicaid.

Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for up to a 24-month transitional period.

Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for up to 24 months.  Or, they may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.

  • Poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage if you are elderly or you are still considered disabled and you continue to have medical need.

  • People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you have high medical expenses that, when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
  • Retired or disabled people who have low-incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.

If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance.  This is called the Qualified Medicare Beneficiary (QMB) program

If your household income is between 100% and 135% of the federal poverty level, Medicaid will pay for your monthly Medicare premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.

  • There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the department of social services.

To obtain the locations and telephone number of an office near you, call the New Jersey Division of Medical Assistance and Health Services at 800-356-1561 or visit them on the web at http://www.state.nj.us/humanservices/dmahs/index.html


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