10 Things to Know About New Jersey Medicaid

TEN THINGS TO KNOW ABOUT NEW JERSEY MEDICAID

by Thomas D. Begley, Jr., Esquire, CELA

            There are a vast number of Medicaid programs in New Jersey.  This article will concentrate on a few of the most used programs.  Medicaid provides medical insurance and services.

1. SSI-linked Medicaid.  If the individual is receiving Supplemental Security Income (SSI), he or she automatically receives Medicaid.  The income and asset rules are the same as SSI.
2. Managed Long-Term Services and Supports (MLTSS).  This is a large Medicaid waiver program.  The program pays for many services including:
   • Nursing homes
   • Assisted living
   • Home care
   • Group Homes
   • Section 8 Housing
   • Disabled Adult Children (DAC)
   • Temporary Assistance for Needy Families (TANF)
   • New Jersey WorkAbility
   • New Jersey Division of Developmental Disabilities (DDD)
   • Pyschiatric

3. NJ FamilyCare.  NJ FamilyCare is a medical assistance program for poor people, is not based on disability, and no Third Party Special Needs Trust is required. 
4. Income Limits.  Most Medicaid programs have income limits. 
   • MLTSS.  In New Jersey and other income cap states, there is an income limit of $2,982, but a work around for this is a Qualified Income Trust (QIT). 
   • NJ FamilyCare.  There is no income limit.  Eligibility for NJ FamilyCare is based on the federal poverty level and income and household size.  In 2026, the maximum income level for an individual is $1,836 per month, while for a family of four the income level is $9,763 per month.
5. Asset Limits. 
   • MLTSS.  The asset limit for MLTSS in New Jersey is $2,000. 
   • NJ FamilyCare.  There is generally an asset limit of $4,000 for an individual and $6,000 for a married couple.
6. Deeming.  Deeming means that assets of other individuals are deemed to the Medicaid applicant. 
   • MLTSS.  There is spousal deeming with minimum CSRA $31,584 and maximum $162,660 for MLTSS.
   • NJ FamilyCare.  There is deeming, which is based on household income.
7. Lookback.
   • MLTSS.  There is a lookback period of five years.
   • NJ FamilyCare.  There is no lookback for asset transfers. 
8. Penalty Calculation.
   • MLTSS.  There is a transfer of asset penalty.  In New Jersey, the penalty is calculated by dividing the state divisor of $420.67 per day into the amount transferred.
   • NJ FamilyCare.  There is no transfer of asset penalty. 
9. Who Can Collect?
   • MLTSS.  To be eligible, the applicant must be disabled.
   • NJ FamilyCare.  Eligibility is based on household income.
10. Determination of Disability.
    • MLTSS.  The State Medicaid Agency will make the Determination of Disability.
    • NJ FamilyCare.  Disability is not required for eligibility.