Medicaid in New Jersey: A Calm, Clear Guide to NJ FamilyCare

If you’ve ever tried to understand Medicaid and walked away feeling more confused than when you started, you’re not alone.

One of the biggest reasons Medicaid feels overwhelming is that it isn’t a single program. In New Jersey, Medicaid is called NJ FamilyCare, and it’s actually a collection of different pathways, each designed for a different stage of life or type of need.

Let’s slow it down and walk through it together.

The Big Picture

NJ FamilyCare can provide health coverage for:

• Low-income adults

• Children and teens

• Pregnant people

• Seniors

• People with disabilities

• People who need long-term care

Which rules apply to you depends on who you are and what kind of care you need. Some categories are based only on income. Others also look at assets, age, disability status, or medical needs.

Adults Ages 19–64 (Medicaid Expansion)

New Jersey participates in Medicaid expansion under the Affordable Care Act.

This category is often what people mean when they say “Medicaid.”

Key features:

• Eligibility is income-based only

• No asset test (savings, property, vehicles do not count)

• Covers adults with or without children

Income limit (2025):

• About 138% of the Federal Poverty Level

• Roughly $1,799 per month for a single adult

• About $21,597 per year

If your income is under this limit and you’re between 19 and 64, this is usually the first pathway to check.

Children and CHIP

Children qualify for Medicaid at much higher income levels than adults.

In New Jersey, children are covered through NJ FamilyCare and the Children’s Health Insurance Program (CHIP).

Key features:

• No asset test

• Broader income limits than adult Medicaid

• Coverage includes:

  • Preventive care and checkups

  • Immunizations

  • Dental and vision care

  • Hospital services

Income limits (2025 examples):

• Infants can qualify up to ~319% FPL

• For a single child household, that’s roughly $4,147 per month

It’s very common for children to qualify for coverage even when their parents do not.

Pregnancy Medicaid

Pregnant people receive more generous Medicaid coverage, both during pregnancy and after birth.

Key features:

• Higher income limits than standard adult Medicaid

• No asset test

• Coverage includes prenatal care, delivery, and postpartum care

Income limit (2025):

• About 194% of the Federal Poverty Level

• Roughly $2,596 per month for a single pregnant person

Postpartum coverage:

• Continues for 12 months after birth

This pathway exists to support health and stability before and after delivery, not just during pregnancy itself.

Aged, Blind, and Disabled Medicaid (Non-MAGI)

This category works very differently from Medicaid expansion.

It applies to people who are:

• Age 65 or older

• Blind

• Disabled (often tied to SSI or disability determinations)

Key features:

• Income limits are lower

• Asset limits apply

• Rules are based on non-MAGI Medicaid, not ACA expansion rules

Typical limits (2025, approximate):

• Income: about 100% FPL

  • Roughly $1,255 per month for a single person

• Assets:

  • About $4,000 for a single person

  • About $6,000 for a couple

People who already receive SSI are often automatically eligible under this category.

An Important New Jersey-Specific Note: Disabled Workers

Some states offer a special Medicaid program for disabled people who are working and earning above standard Medicaid limits.

New Jersey does not.

There is no Medicaid for disabled workers program in NJ.

If someone is disabled and working, they must qualify under:

• A standard Medicaid category, or

• Long-term care Medicaid, or

• Medicare Savings Programs (which help with Medicare costs but are not full Medicaid)

This is an important difference that often surprises people.

Long-Term Care and Home & Community-Based Services

Medicaid can also help when someone needs ongoing, nursing-facility-level care, either in a nursing home or at home.

This category has its own financial rules.

Key features:

• Applies to:

  • Nursing home care

  • Home & Community-Based Services (HCBS)

• Both medical need and financial eligibility must be met

Financial limits (2025, approximate):

• Income:

  • About 300% of the Federal Benefit Rate

  • Roughly $2,901 per month for a single applicant

• Assets:

  • About $2,000 for a single person

  • About $3,000 if both spouses are applying

Other important rules:

• A 60-month look-back applies to asset transfers

• A primary home is usually exempt up to a high equity limit (over $1,000,000) if the person lives there or intends to return

Planning matters a great deal in this category.

Medically Needy / “Spend-Down” Medicaid

New Jersey also offers a Medically Needy program for people whose income is too high for standard Medicaid but whose medical costs are significant.

Key features:

• Income limits are very low on paper

• Qualifying medical expenses can be deducted

• Eligibility is measured over six-month periods

Typical limits:

• Income threshold may be around $367 per month for a single person

• Assets:

  • About $4,000 single

  • About $6,000 couple

This pathway can be especially helpful for people with chronic illness, disability, or high ongoing medical expenses.

Why Medicaid Feels So Confusing

“Medicaid” doesn’t mean the same thing for everyone.

The rules change based on:

• Age

• Disability status

• Pregnancy

• Income

• Assets

• Medical care needs

Some people qualify because their income is low.
Some qualify only if both income and assets are low.
Some qualify because medical needs are high enough to override income limits.

Understanding which pathway applies can make a meaningful difference — especially when planning around work, family changes, or long-term care.

A Final Thought

This guide isn’t meant to overwhelm you.

It’s meant to remind you that Medicaid is not a single door, but many — and if one doesn’t fit, another might.

You don’t have to understand everything at once. Sometimes clarity comes one step, one category, one quiet cup of tea at a time.