Medicaid eligibility and enrollment

There are many ways to qualify for Medicaid coverage whether due to disability, SSI, or otherwise. 

Visit the Division of Developmental Disabilities website for a comprehensive resource to determine if you qualify.

DDD Medicaid Eligibility

 

Changes effective April 1, 2023

During the Public Health Emergency (PHE), people's Medicaid coverage was not being terminated, even if they no longer qualified.  

Over a 12-month period, starting on April 1, 2023, NJ FamilyCare is going to start re-determining members eligibility. 
This means that all members enrolled in an NJ FamilyCare program will be reviewed to see if they still qualify.

 

NJ FamilyCare/Medicaid has already started sending out renewal packets to Medicaid Members.  

If you receive one of these packets, it is very important for you to respond, even if nothing has changed, to avoid potential disenrollment.

 

What can you do to prepare?

Call NJ FamilyCare/Medicaid at 1-800-701-0710 (TTY: 711) to update your contact information.  This is especially important if you have moved in the last three years.

Watch for mail from the State of New Jersey or your county, and make sure you reply on time to avoid a cap in coverage.

What if you receive a Medicaid termination notice?

You must submit a written request to the Division of Medical Assistance & Health Services (DMAHS) within 20 calendar days of the date on the notice. NJAC 10:49-10.3(b)(3) 
10 days if you want your benefits to continue during the proceedings
The written request does not need to be in a particular format but should be a “clear expression” of the person’s “desire of the opportunity to present their case to a higher authority”
Your notice should include a written form you can use
DMAHS will submit your request for Fair Hearing to the Office of Administrative Law (OAL) within 20 days
Here is an example of a sample letter.

• Your denial notice will explain how to properly request a Medicaid Fair Hearing.
• Retain copy of your denial letter
• KEEP PROOF that you sent the request (fax confirmation, certified mail receipt)
• Mail to:
  State of New Jersey
  Division of Medical Assistance and Health Services
  Fair Hearing Unit
  P.O. Box 712
  Trenton, NJ 08625-0712
• Fax to: DMAHS fair hearing unit 609-588-2435