Medicaid is a joint federal and state program that helps pay medical costs if you have limited income and /or resources and meet other requirements. People with Medicaid may get coverage for services that Medicare may not or may partially cover, like nursing home care, personal care, and home-and community-based services. Each state has different rules about eligibility and applying for Medicaid. If you qualify for Medicaid in your state, you automatically qualify for Extra Help paying your Medicare prescription drug coverage (Part D).

You may be eligible for Medicaid if you have limited income and are:

  • · 65 or older
  • · A child under 19
  • · Pregnant
  • · Living with a disability
  • · A parent or adult caring for a child
  • · An adult without dependent child (in certain states)
  • · An eligible immigrant

In many states, more parents and other adults can get coverage now. If you were turned down in the past, you can try again and may qualify.


When you enroll, you may be able to get health care benefits like:

  • · Doctor visits
  • · Hospital stays
  • · Long-term services and support
  • · Preventive care, including immunizations, mammograms, colonoscopies, and other needed care
  • · Prenatal and maternity care
  • · Mental health care
  • · Necessary medications
  • · Vision and dental care (for children)

Dual eligibility

Some people qualify for both Medicare and Medicaid. They’re called “Dual Eligible”. If you have Medicare and full Medicaid coverage, most of your health care cost are likely covered.

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). If you have Medicare and/or

Programs

Please note that income and resource limits listed for eligibility for a specific program can change from year to year. If you need one of these types of assistance, check for current limits with your local Department of Health and Human Services office. All numbers are for 2020 unless otherwise noted.

ABD -Aged Blind Disabled.

Programs provides medical coverage hospitalizations and medications to individuals who are age 65 years or older as well as individuals determined blind or disabled by the Social Security Administration or by the State of NJ and have an income (in 2022) of less than $1,367 for an individual or $1,842 for a couple. There is a resource limit (in 2022) of $4,000 for an individual or $6,000 for a couple. It is designed for people whose income and resources are not enough to meet the cost of necessary care and services. The individual must be a resident of New Jersey and a citizen of the United States or Qualified Immigrant. An adult must have Legal Permanent Residence status for at least five years.

Covered Benefits

Comprehensive and quality services include, but are not limited to:

  • Dental
  • Eyeglasses
  • Doctor Visit
  • Specialist Visits
  • Hospitalization
  • Prescriptions
  • Lab tests and X-rays
  • Rehabilitative Care
  • Mental Health
  • Substance Use
  • Long Term Services and Supports 

Services provided by:

Aetna (Aetna Better Health of New Jersey)

Horizon (Horizon NJ Health)

Amerigroup (Real Solutions in Health Care)

United Health Care (Community)

Well Care

Supplemental Security Income (SSI)

Program administered by the Social Security Administration, is a federal program that provides monthly payments to eligible individuals who are 65 years of age or older and persons determined blind or disabled by the Social Security Administration. In New Jersey, individuals that are determined to be eligible for SSI automatically receive full NJ Family Care ABD Program benefits.

An individual may be eligible for SSI in New Jersey in 2020 if his/her gross monthly income is equal to or less than $814.25 or $1,200.36 for a couple (the first $20 per month of income is excluded). The current resource maximum for an individual is $2,000 and $3,000 for a couple.

For more information about SSI, or to apply for SSI benefits, please contact the Social Security Administration at 1-800-772-1213.

Medicaid Only

The Medicaid Only Program is an Aged, Blind, Disabled Program for individuals who do not receive SSI but have income and resources under the SSI standards listed above.

New Jersey Care… Special Medicaid Programs

The New Jersey Care… Special Medicaid Programs are for individuals with gross monthly income that is equal to or less than 100% of the Federal Poverty Level which is $1,367 per month for a single person and a resource maximum of $4,000; $1,842 per month for a couple and a resource maximum of $6,000 in 2022.

NJ WorkAbility

The NJ WorkAbility Program offers full health coverage to people ages 16-64 with disabilities who are working, to obtain coverage when their gross monthly Social Security Disability Income would otherwise disqualify them from other programs.


Eligibility Criteria

  • Age 16-64

    • Working full or part-time with proof of employment

    • Determined as disabled by the Social Security Administration OR the Disability Review Team at the Division of Medical Assistance & Health Services

    • Income and asset eligibility as described below

Total Earned Income Potential

Includes but is not limited to wages, self-employment earnings, workers’ compensation, paid sick leave, private or state temporary disability plan benefits or commissions.

• If you have no unearned income:

Individual gross earned income may not exceed $64,596 per year/ $5,383 per month.

An eligible couple’s gross earned income may not exceed $86,988 per year/$7,249 per month.

• If you have unearned income (for example, in addition to your wages you also receive alimony), the maximum earned income threshold will vary

Unearned Income Threshold

Includes but is not limited to alimony, Social Security Survivors’ Benefits through a parent or spouse’s work history, unemployment, interest, investments, or trust payments.

• An individual’s unearned income may not exceed $1,367 per month.

• An eligible couple’s unearned income may not exceed $1,842 per month.

Asset Threshold:

Assets do not include primary home, a car used for work or medical transportation, or 401K/IRA retirement accounts.

• $20,000 for an eligible individual

• $30,000 for an eligible couple

Important Note: Portions of both earned and unearned income are not counted when determining eligibility for Workability. Please apply for a full eligibility determination using the NJ Family Care Aged, Blind, Disabled Programs Application.