NJ FamilyCare To Start “Unwinding” Eligibility For 2 Million Members

NJ FamilyCare (Medicaid) Updates

The 2023 income limits for NJ FamilyCare (Medicaid) eligibility have been released. The new income chart is below.


Planning for the Unwinding

Since March of 2020, NJ FamilyCare/Medicaid has followed special rules related to the federal COVID-19 Public Health Emergency (PHE). These rules have allowed most NJ FamilyCare/Medicaid members to keep their health coverage, even if they no longer qualified – for example, if their income was too high. However, once the federal government determines that the PHE is over, NJ FamilyCare will have to follow normal federal rules.

Many states have already instituted or are planning to institute the unwinding process for redetermination of Medicaid eligibility, including New Jersey.

NJ FamilyCare is going to start re-determining members’ eligibility on April 1, 2023. This means that all members enrolled in an NJ FamilyCare program will be reviewed to see if they still qualify for coverage. As part of this review, many members will receive mail from the State of New Jersey or their County Board of Social Services. Members will have to provide or confirm additional information so NJ FamilyCare/Medicaid can decide whether they still qualify for healthcare coverage. Members who do not respond to NJ FamilyCare/Medicaid mail will lose their coverage. The notification will by via regular mail, so beware of emails or texts that ostensibly look like they are coming from NJ FamilyCare.

What is unwinding?

“Unwinding” is the process where New Jersey will restart yearly eligibility reviews for everyone enrolled in NJ FamilyCare/Medicaid. This will happen starting April 1, 2023.

What happens during unwinding?

During the unwinding, NJ FamilyCare/Medicaid will send renewal packets for members to complete and return. Then NJ FamilyCare/Medicaid will decide if members still qualify for coverage. You can learn more about who can qualify here. Members who still qualify will keep their NJ FamilyCare/Medicaid coverage.

When will NJ FamilyCare/Medicaid restart eligibility checks?

New Jersey will resume the ordinary eligibility processes for everyone enrolled in NJFamilyCare/Medicaid in April 2023. At that time, NJ FamilyCare will begin checking eligibility for over 2,000,000 NJ FamilyCare members.

What can members do to prepare for the return to annual eligibility checks?

  • Call NJ FamilyCare/Medicaid at 1-800-701-0710 (TTY: 711) to update their contact information. This is especially important if they have moved in the last three years.
  • Watch for mail from the State of New Jersey or your county, and make sure to reply on time to avoid a gap in coverage.

What happens if members no longer qualify for NJ FamilyCare/Medicaid?

Members should take time to make sure the renewal process goes smoothly by responding to requests for information and reporting changes in their household like pregnancy, address, income, and so on. Those members determined to be eligible will continue to receive NJ FamilyCare/Medicaid benefits.

If a member no longer qualifies for coverage through NJ FamilyCare/Medicaid, they may be referred to GetCoveredNJ, where they can get help paying for healthcare coverage. GetCoveredNJ is the state’s official health insurance marketplace where individuals and families can easily shop for and buy affordable healthcare coverage.

A member who has lost coverage but believes they still qualify should call their County Board of Social Services or the NJ FamilyCare health benefits coordinator at 1-800-701-0710 (TTY: 711).

What about Medicare?

If a member has Medicare, they may qualify for help with premiums, co-pays, and deductibles through New Jersey’s Medicare Savings Programs. Learn more about program eligibility and benefits by calling 1-609-792-9745 (TTY: 711).

You can also contact the LRRC for assistance with this process as soon as you receive a termination letter.

For any questions, you can schedule an appointment with an LRRC caseworker by calling 732-523-1789 or visiting us during our walk-in hours.

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