NJ Family Care
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Questions and Answers

Below is a general list of frequently asked questions. If you don't see your questions listed below, please call NJ FamilyCare at 1-800-701-0710 and speak to a Health Benefits Coordinator.

Will there be any eligibility changes for kids or parents because of The Affordable Care Act?

I am enrolled in the NJ FamilyCare/Health Access program, will I continue to be eligible?

Are parents/guardians eligible for NJ FamilyCare?

What does it mean that I have to renew my insurance every 12 months?

Is it true that applicants for NJ FamilyCare must be without health insurance for 3 months before they can be eligible?

I have a job out of state. The health insurance I receive is not accessible to my family. Will they qualify for NJ FamilyCare in spite of the fact that I have insurance?

I am a single adult. Can I still qualify for the NJ FamilyCare program?

If I am an adult without dependent children and had a prior criminal offense which was classified as a felony or crime involving the possession, use, or distribution of a controlled substance, can I still get childless adult Medicaid coverage?

My family came to the United States two years ago. Could they be eligible for NJ FamilyCare?

I don't speak English very well and I am afraid to call.

How do I apply?

Can I apply at my County Welfare Agency?

I cannot make up my mind as to which Health Plan to select. What should I do?

If I have to pay a monthly premium, how important is it to send in my check once I receive notice?

Can I keep the same doctor I have now?

I have lost my job and can no longer afford the premiums for NJ FamilyCare. Is there anything I can do to maintain coverage for my children?

What if my family makes too much money to qualify for NJ FamilyCare?

What is the NJ FamilyCare Advantage program?

What if I'm Pregnant?

Will there be any eligibility changes for kids or parents because of The Affordable Care Act?

Yes; beginning in October 2013, adults with income over 133% of the Federal Poverty Level will be ineligible for NJ FamilyCare but will be referred to the new Federal Health Insurance Marketplace. Visit www.healthcare.gov for other affordable health insurance programs. Current adult enrollees affected by the new eligibility thresholds will be contacted by mail letting them know that their existing insurance will end on December 31, 2013.

For Pregnant Women: There is no change to eligibility. Pregnant women already enrolled in NJ FamilyCare should contact 1-800-701-0710 and advise them of your pregnancy. NJ FamilyCare wants to be sure you are receiving all of the benefits that your pregnancy entitles you to.

For Children: Eligibility for coverage remains up to 350% FPL.

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I am enrolled in the NJ FamilyCare/Health Access program, will I continue to be eligible?
No. As a result of subsidized health coverage available through the Affordable Care Act (ACA), the State funded Health Access program will end on December 31, 2013.
However, through ACA, the federal government has made subsidized health insurance and tax credits, for the purchasing health insurance, available through their new online Health Insurance Marketplace (Marketplace). The Marketplace will begin to accept applications for enrollment beginning October 1, 2013. If you are eligible, your new benefits could begin January 1, 2014. Visit www.healthcare.gov for more information.

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Are parents/guardians eligible for NJ FamilyCare?
Beginning October 1, 2013, NJ FamilyCare will accept applications from ALL adults with income at or below 133% of the federal poverty level.

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What does it mean that I have to renew my insurance every 12 months?
Renewal is simply a way of checking to see if anything has changed in your family's situation. You may be sent a preprinted form to confirm your income status and household size or you may be sent a blank application to fill out. It is very important that you immediately respond to any written request so that your insurance coverage will not be lost or interrupted.

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Is it true that applicants for NJ FamilyCare must be without health insurance for 3 months before they can be eligible?
Yes, this is true. However, there are exceptions to this rule, such as if you lost your insurance because your place of work went out of business or you were laid off. Depending on income, other exceptions may apply for families privately paying for health insurance or for COBRA benefits. We strongly urge you to call 1-800-701-0710 and speak with a Health Benefits Coordinator to find out if any exceptions apply to you.

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I have a job out of state. The health insurance I receive is not accessible to my family. Will they qualify for NJ FamilyCare in spite of the fact that I have insurance?
Yes, if your health insurance is not accessible to your family, they may be eligible for NJ FamilyCare.

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I am a single adult. Can I still qualify for the NJ FamilyCare program?
Open Enrollment begins October 1, 2013. At that time NJ FamilyCare will begin accepting applications for all adults with income under 133% of the Federal Poverty Level. For some adults, their benefits could begin right away, for others, the benefits may not begin until January 2014. Immigrants who are legal permanent residents of the US must have had that status for at least five years in order to be eligible for NJ FamilyCare.

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If I am an adult without dependent children and had a prior criminal offense which was classified as a felony or crime involving the possession, use, or distribution of a controlled substance, can I still get childless adult Medicaid coverage?

Prior to January 1, 2014: The Division does not directly consider any prior offense involving possession, use, or distribution of controlled substances in a Medicaid eligibility determination; however, currently, being eligible for Work First New Jersey/General Assistance (WFNJ/GA) is a requirement to become eligible for childless adult Medicaid coverage. The WFNJ/GA eligibility rules provide that if an adult without dependent children has a conviction that involves possession or use of a controlled substance, that person can become eligible for WFNJ/GA only if they enroll in and complete a licensed residential drug treatment program and undergo drug testing during the treatment program and for 60 days thereafter. A failed drug test will cause WFNJ/GA benefits to terminate, and this would affect Medicaid eligibility. The WFNJ/GA eligibility rules also provide that if an adult without dependent children was convicted of distribution of a controlled substance, the person cannot qualify for WFNJ/GA. Therefore the person cannot currently qualify for childless adult Medicaid.

As of January 1, 2014: The federal Patient Protection and Affordable Care Act will provide, for States that choose to participate, that States can offer Medicaid eligibility to adults without dependent children under federal guidelines that do not include requiring the person to be eligible for WFNJ/GA. Therefore, prior drug convictions for possession, use or distribution of controlled substances will no longer be a factor in Medicaid eligibility because eligibility for WFNJ/GA will no longer be a consideration in Medicaid eligibility for adults without dependent children as of January 1, 2014.

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My family came to the United States two years ago. Could they be eligible for NJ FamilyCare?
Children age 18 or under who are lawfully admitted for permanent residence can be eligible even if they have lived in this country less than five years. Immigrant parent/guardians who are legal permanent residents of the US must have had that status for at least five years in order to be eligible for NJ FamilyCare.

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I don't speak English very well and I am afraid to call.
NJ FamilyCare's 800 number is linked with a translation service. Whatever your native language is, we will arrange to have a third person on the line who can speak your language. They will be there to interpret for you and the Health Benefits Coordinator. Don't be afraid! Call 1-800-701-0710!

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How do I apply?
There are several ways you can apply:


We strongly encourage you to Apply Online. If you need help, call the toll free 1-800-701-0710 and a Health Benefits Coordinator will help you.

If you prefer to have face to face assistance, click on the Need Help Enrolling link of this web site and a list of application assistant sites in your county will appear. Choose a site that offers personal assistance and they will be able to help you apply.

You can also download the application and mail it to: PO Box 8367, Trenton, NJ 08650

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Can I apply at my County Welfare Agency?
Yes, you can. Actually, if your income is low at this time, it would be a very good idea to apply at a County Welfare Agency. There is a possibility that you might be eligible for other programs, such as food stamps. The representatives at the County Welfare Agency will be able to help you. You can find your County Welfare Agency's address and telephone number by going to "Need help enrolling?" and then click on your county of residence. They will be listed there.

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I cannot make up my mind as to which Health Plan to select. What should I do?
First you should check out the list of NJ FamilyCare Health Plans, and see which are available in your County. Then you should contact your family doctor to see if he or she is participating in one of those Health Plans - be sure to specify NJ FamilyCare when you ask. If not, we recommend that you call our 800 number to have one of our Health Benefits Coordinators assist you. Make a selection even if you are not sure. Not choosing a Health Plan will SLOW DOWN your application. Once your family members are enrolled in NJ FamilyCare, you will have an opportunity to change your Health Plan at a later date, if you are not satisfied.

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If I have to pay a monthly premium, how important is it to send in my check once I receive notice?
It is very important that you send in your payment as soon as you know your monthly premium. You will receive notice of your premium by mail. New members cannot be enrolled until the full payment has been received. Once enrolled you will be billed monthly. It must be paid in full and on time in order to continue enrollment.

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Can I keep the same doctor I have now?
Yes, if your doctor is a participant of one of the Health Plans providing services for NJ FamilyCare in your county. Call your doctor and ask if he or she is providing services for NJ FamilyCare and if so, under which HMO. Then choose that HMO as your health care provider.

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I have lost my job and can no longer afford the premiums for NJ FamilyCare. Is there anything I can do to maintain coverage for my children?
You can call 1-800-701-0710 and request a status change. Your family's eligibility status will then be reevaluated based on current income, and could result in your paying a lower premium or no premium.

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What if my family makes too much money to qualify for NJ FamilyCare?
NJ residents at higher income levels can purchase health insurance through the Federal Health Insurance Marketplace www.healthcare.gov

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What is the NJ FamilyCare Advantage program?
The NJ FamilyCare Advantage program is available to children only in families with incomes above 350% of the FPL (over $78,225 a year for a family of 4, or $6,519 per month). A parent/guardian can purchase coverage for a child under the age of 19 who is uninsured through Horizon. Please visit: www.horizonnjhealth.com/ourplans/njfamilycareadvantage/about-plan-affordable-health-care-your-children or call 1-800-637-2997.

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What if I'm Pregnant?
NJ FamilyCare covers low income pregnant women too! Apply online at www.njfamilycare.org or visit your local County Welfare Agency. Contact the respective local County Welfare Agency in your area.

Pregnant women already enrolled in NJ FamilyCare should contact 1-800-701-0710 and advise them of your pregnancy. NJ FamilyCare wants to be sure you are receiving all of the benefits that your pregnancy entitles you to.

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