Understanding Medicaid & New Jersey FamilyCare: A Simple Guide

There are several types of Medicaid (also called New Jersey FamilyCare) programs in New Jersey, and each has its own eligibility rules. The rules can be complicated. If you live in Middlesex, Mercer, or Union County, Central Jersey Legal Services (CJLS) may be able to help. CJLS is a nonprofit law firm that provides free legal help to people who cannot afford an attorney. Call our office at 732-249-7600 to see if you qualify for our services.

These are the main programs:

1. ACA Medicaid (Affordable Care Act Medicaid)

• • Who qualifies?
    • Adults Ages 19–64 who are not eligible for Medicare
    • People who receive Social Security Disability for 24 months usually become Medicare eligible and cannot get ACA Medicaid
  • Income limit (2025):
    • 138% of the federal poverty level – $1,800/month for a single person
    • Amount of income varies by household size
  • Asset limit:
    • No asset limit — your bank balance or savings won’t affect eligibility

2. ABD Medicaid (Aged, Blind, or Disabled)

• • Who qualifies?
    • People age 65+ or who have a qualifying disability
    • Can be enrolled in Medicare and still get ABD Medicaid. This is called “dual eligible.”
  • Income limit (2025):
    • 100% of the federal poverty level. $1,305/month for a single person or $1,763/month for a household of 2
    • Some income is not counted, including the first $20 of unearned income and part of wages
    • If you live with someone rent-free or someone else pays for your food or housing, that may be counted as income
  • Asset limit (includes cash, bank accounts, retirement accounts, etc.):
    • $4,000 (single)
    • $6,000 (couple)

3. NJ Workability Program

• • Who qualifies?
    • People age 16 or older with a disability
    • Must be working
    • Must be dual eligible with Medicare
  • Income limit:
    • No strict income cap, but if income is over 250% of the poverty level (about $3,260/month for a single person), you may need to pay a monthly premium
    • Social Security Disability income and your spouse’s income are not counted
  • Asset limit:
    • No asset limit — your bank balance or savings won’t disqualify you

4. MLTSS (Managed Long Term Services and Supports)

For people who need long-term care, either at home or in a nursing facility

• • Who qualifies?
    • Must need a nursing home level of care (can be provided at home)
  • Income limit (2025):
    • $2,901/month
    • If over the limit, you can set up a Qualified Income Trust (QIT) to become eligible
  • Asset limit:
    • $2,000 for a single person
    • Some assets, like your primary home and one car, are not counted
  • Special note:
    • If you are married, there are special rules to protect the spouse
    • 5-year lookback period: When you apply, Medicaid will review your financial history for the past 5 years. If you gave away money or property during this time in order to become eligible, Medicaid may say you’re ineligible for a certain amount of time

5. SSI Medicaid

For people who receive Supplemental Security Income (SSI)

• • Who qualifies?
    • If you are approved for SSI, you automatically get SSI Medicaid — no separate application needed
  • Income limit (2025):
    • Must be under the SSI benefit rate, $998.25/month in 2025
  • Asset limit:
    • $2,000
  • Note:
    • People on SSI usually do not have enough work history to qualify for Social Security Disability Insurance (SSDI)

6. Medicare Savings Programs

For people with Medicare who need help with costs

• • Who qualifies?
    • People with Medicare who meet income and asset limits
  • Income limits (2025):
    • $1,305–$1,761/month (single)
    • $1,763–$2,380/month (married couple)
  • Asset limits:
    • Up to $9,660 (single)
    • Up to $14,470 (couple)
  • What’s covered?
    • Help paying for Medicare Part A and B premiums
    • Assistance with deductibles, coinsurance, and copayments
  • How to apply:
    • Use the NJ Save application (available online or by mail)
    • The application also checks your eligibility for other helpful programs, like prescription and utility assistance

The purpose of this article is to present a general overview of Medicaid programs. It is not intended to be used as legal advice. Each client’s case is unique and merits individual legal advice from an attorney.