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Learn About Requirements for Medicaid in New Jersey

Potential applicants who are wondering “What are the requirements for Medicaid in New Jersey?” are far from alone, as nearly 20 percent of the state population participates in the program. Residents must understand how to qualify for Medicaid to become a beneficiary of the program. The Division of Medical Assistance and Health Services (DMAHS) administers all of New Jersey’s state and federally funded health care programs. Petitioners who want to meet Medicaid benefits eligibility must fall within a category of groups of people covered and meet any income requirements. The Medicaid eligibility requirements are complex and examined by caseworkers according to each petitioner’s circumstances. Petitioners who want to understand the requirements for Medicaid in NJ can carefully review the information below.


Who qualifies for Medicaid in New Jersey?

Those who qualify for Medicaid in New Jersey have a low- to moderate-income financial status and are in need of health care. To meet Medicaid eligibility guidelines, every applicant is required to be a resident of New Jersey. Petitioners must be a U.S. national, citizen, legal alien or permanent resident. However, those who are ineligible for Medicaid due to their immigration status may still qualify for emergency treatment, provided they meet all other Medicaid eligibility requirements. Many children and certain pregnant women can also qualify for NJ Medicaid.

Eligibility for Medicaid benefits is also extended to residents who are 65 years of age and older and persons who are disabled or blind. Applicants who qualify for Medicaid benefits in NJ through a disability must be able to provide official documentation for verification. Residents will automatically qualify for Medicaid benefits if they participate in the Supplemental Security Income (SSI) program.

What are the income requirements for Medicaid in New Jersey?

The income requirements for Medicaid in New Jersey broadened in April 2010, when New Jersey became one of the states that accepted the Affordable Care Act (ACA) Medicaid expansion. The ACA was enacted to help states expand their Medicaid coverage and have reduce the amount of residents living uninsured. More residents were able to qualify for Medicaid in NJ and receive comprehensive health care once the Medicaid expansion was enacted. Those who qualify for Medicaid coverage through the ACA are residents who have a low income. However, they may have previously been ineligible for Medicaid because they did not meet the program’s other eligibility requirements, such as having children or having a disability.

New Jersey decided to expand Medicaid eligibility to low-income adults with an income up to 138% of the Federal Poverty Level (FPL). Children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) with household income up to 355% of the FPL. Medicaid benefits eligibility for pregnant women and other groups have their own income requirements. To learn more about income limits for Medicaid, download our free Medicaid guide today.

Applicants who meet income requirements for Medicaid in New Jersey will receive immediate Medicaid coverage. The state may also take into consideration a candidate’s countable resources. Resources that may be considered include bank accounts, real estate, stocks, bonds, trust funds, certificates of deposit and cash. When it comes to determining eligibility for Medicaid benefits, not everything is considered a countable resource. Those who meet Medicaid benefits eligibility in NJ are only allowed to have a certain amount of resources available. Some applicants may still be able to meet Medicaid eligibility standards even if they have an income that exceeds the income limit. These petitioners may qualify for Medicaid benefits through the Medically Needy program, permitting they meet the requirements for a qualifying condition.

What are the Medicaid application guidelines in New Jersey?

Petitioners who find that they qualify for Medicaid in NJ can apply in a few different ways for benefits. Applicants can apply in person and turn in their application to their local NJ Family Care office or apply online. Medicaid has no deadline. If an applicant meets all Medicaid benefits requirements, he or she can receive Medicaid benefits immediately. Medicaid can even provide coverage to participants retroactively. This feature of the program helps by allowing patients that have recently met Medicaid benefits eligibility to use their new found insurance benefits to pay for any medical services and bills they may have had pending. Perhaps the simplest way to apply for benefits is through the state’s online portal. Applicants are able to receive their determination more quickly and keep an eye on the status of their application. To learn more about Medicaid application guidelines, you can download our free guide today.