Questions and Answers

Below is a general list of frequently asked questions. If you don't see your questions listed below, PLEASE call NJ FamilyCare at 1-800-701-0710 and speak to a Health Benefits Coordinator. It is suggested that at anytime a family member contacts a Health Benefits Coordinator, they keep a record of the day and time and the name of the person who assisted them.

Can parents/guardians apply for NJ FamilyCare?
NJ FamilyCare is only accepting applications from parents/guardians at or below 133% of the federal poverty level. For example, parents/guardians in a family of four, making up to $2,444 per month, would be able to apply. Prior to March 1, 2010, parent/guardians with earnings up to 200% of FPL could be found eligible for NJ FamilyCare.

What does it mean that I have to renew my insurance every 12 months?
Renewal is simply a way of checking to see if anything has changed in your family's situation. You may be sent a preprinted form to confirm your income status and household size or you may be sent a blank application to fill out. It is very important that you immediately respond to any written request so that your insurance coverage will not be lost or interrupted.

How do I know if my family will qualify for NJ FamilyCare?
NJ FamilyCare is affordable health insurance for children and certain low-income parents. The primary qualifications are simple: 1) they haven't had health insurance in the past 3 months (with a few exceptions) and 2) your family monthly income falls within the guidelines listed in the "Income Eligibility and Cost" section of this web site.

Is it true that applicants for NJ FamilyCare must be without health insurance for 3 months before they can be eligible?
Yes, this is true. However, there are exceptions to this rule, such as if you lost your insurance because your place of work went out of business or you were laid off. Depending on income, other exceptions may apply for families privately paying for health insurance or for COBRA benefits. We strongly urge you to call 1-800-701-0710 and speak with a Health Benefits Coordinator to find out if any exceptions apply to you.

I have a job out of state. The health insurance I receive is not accessible to my family. Will they qualify for NJ FamilyCare in spite of the fact that I have insurance?
Yes, if health insurance is not accessible to your family, they may be eligible to apply for NJ FamilyCare.

I am a single adult. Can I still qualify for the NJ FamilyCare program?
No, to assure that there would be sufficient funding for children, NJ FamilyCare had to stop taking applications for adults and couples without dependent children on September 1, 2001.

My family came to the United State two years ago. Could they be eligible for NJ FamilyCare?
Children age 18 or under who are lawfully admitted for permanent residence can be eligible even if they have lived in this country less than five years. Immigrant parent/guardians who are legal permanent residents of the US must have had that status for at least five years in order to be eligible for NJ FamilyCare. Documentation of immigration status will be requested along with the application.

I don't speak English very well and I am afraid to call.
NJ FamilyCare's 800 number is linked with a translation service. Whatever your native language is, we will arrange to have a third person on the line who can speak your language. They will be there to interpret for you and the Health Benefits Coordinator. Don't be afraid! Call 1-800-701-0710!

How do I apply?
There are several ways you can apply:

• By mail - call 1-800-701-0710 and ask for an application. The application will be sent to your home. Complete the application; return all of the required information in the self addressed stamped envelope.
• By downloading the application and mailing it to:
  PO Box 8367, Trenton, NJ 08650.
• By completing the online application and submitting it electronically.

Can I apply at my County Welfare Agency?
Yes, you can. Actually, if your income is low at this time, it would be a very good idea to apply at a County Welfare Agency. There is a possibility that you might be eligible for other programs, such as food stamps. The representatives at the County Welfare Agency will be able to help you. You can find your County Welfare Agency's address and telephone number by going to "Need help enrolling?" and then click on your county of residence. They will be listed there.

Do you think I should make a copy of all the paperwork before I send it?
YES! you should keep a copy of the completed application, as well as all of the documents.

I cannot make up my mind as to which HMO to select. What should I do?
First you should check out the list of NJ FamilyCare HMO's, and see which are available in your County. Then you should contact your family doctor to see if he or she is participating in one of those HMO's - be sure to specify NJ FamilyCare when you ask. If not, we recommend that you call our 800 number to have one of our Health Benefits Coordinators assist you. Make a selection even if you are not sure. Not choosing an HMO will SLOW DOWN your application. Once your family members are enrolled in NJ FamilyCare, you will have an opportunity to change your HMO at a later date, if you are not satisfied.

If I have to pay a monthly premium, how important is it to send in my check once I receive notice?
It is very important that you send in your payment as soon as you know your monthly premium. You will receive notice of your premium by mail. New members cannot be enrolled until the full payment has been received. Once enrolled you will be billed monthly. It must be paid in full and on time in order to continue enrollment.

Can I keep the same doctor I have now?
Yes, if your doctor is a participant of one of the  HMO's providing services for NJ FamilyCare in your county. Call your doctor and ask if he or she is providing services for NJ FamilyCare and if so, under which HMO. Then choose that HMO as your health care provider.

I sent in my application four weeks ago and have not heard anything. What should I do?
If you mailed an application or submitted an online application to the State Health Benefits Coordinator 4 weeks ago and have not heard anything, call 1-800-701-0710 and ask about the status of your application. Ask for your policy ID number for future reference. If your application was sent to your local County Welfare Agency, call them to inquire about the status and to get your case number.

I have lost my job and can no longer afford the premiums for NJ FamilyCare. Is there anything I can do to maintain coverage for my children?
You can call 1-800-701-0710 and request a status change. Your family's eligibility status will then be reevaluated based on current income, and could result in your paying a lower premium or no premium.

What if my family makes too much money to qualify for NJ FamilyCare?
Parents/guardians at higher income levels can purchase health insurance for their children at reasonable rates through the NJ FamilyCare ADVANTAGE program administered by Horizon NJ Health if they qualify. The cost is $144 per month for one child; $288 per month for two children; and $432 per month for three or more children. To learn more, please visit www.horizonnjhealth.com/members/advantage.html or call 1-800-637-2997.


Questions and Answers -
Changes Effective March 1, 2010

What will change and who will be affected?
Parents/guardians who have not resided in the US as Legal Permanent Residents for at least 5 years are no longer eligible for NJ FamilyCare after March 31, 2010.

New applications from parents/guardians with income over 133% of the Federal Poverty Level will no longer be accepted as of March 1, 2010.

What will not change?
There are no changes for children's enrollment in the NJ FamilyCare Program. NJ FamilyCare will continue to process eligibility for children. There are no changes to pregnant women, New Jersey Care...Special Medicaid Programs for pregnant women through the County Welfare Agencies is still available. Any pregnant women, regardless of date of entry can apply and be determined eligible. To find the local County Welfare Agency near you click here.

Why are these changes happening?
The NJ FamilyCare program is supported by both State and Federal funds. New Jersey is facing an unprecedented financial crisis and without a change in the program, we will run out of State funding before the end of this fiscal year.

Who will be eligible for NJ FamilyCare?
Children - US Citizens and Qualified Immigrants, regardless of date of entry, up to age 19 and up to 350% FPL.

Parent/Guardian - US Citizens and Qualified Immigrants including those with legal permanent resident status of at least 5 years with income up to 133% of the Federal Poverty Level could be eligible. All other beneficiaries currently receiving services will stay on the program as long as they continue to meet the program requirements in effect prior to March 1, 2010.

Pregnant women are still eligible for services through their local County Welfare Agency.

Where can I go if I need health care?
Federally Qualified Health Centers (FQHCs) offer medical care through a number of community health centers operating throughout the state. These centers are federally supported and offer a wide array of medical, dental and other services on a sliding-fee basis. To find a location near you, visit www.njpca.org/FQHC/directory.aspx.

Where can I get health insurance?
You may be eligible for coverage in the commercial individual market. Unlike NJ FamilyCare, the individual market is not subsidized, and the prices reflect that. Information is available on the Department of Insurance web site at: www.state.nj.us/dobi/reform.htm.

What if I'm in the middle of treatment or will begin treatment shortly for a serious illness?
NJFC regrets that the insurance had to end for many of our beneficiaries. If your coverage has been discontinued. Prior to termination, you can contact your HMO for information regarding potential resources for continuing care needs. The HMO may be aware of resources to assist families. The telephone number is on the back of the HMO Insurance ID card. The Medicaid Customer Service Office can also be reached at 1-800-356-1561.

What if I'm Pregnant?
Services for Pregnant Women are available through the local County Welfare Agency. Contact the respective local County Welfare Agency in your area.

Pregnant women on NJ FamilyCare through the State Vendor should contact NJ FamilyCare at 1-800-701-0710 to advise them of the pregnancy.

Can Parents still apply for NJ FamilyCare?
US Citizen Parents/Guardians and Qualified Adult Immigrants: Certain low-income parents with incomes below 133% FPL ($29,327 for a family of four (4) 2009 Guidelines) may still be eligible for health coverage, and should apply. The NJ FamilyCare program is not closed to parents with work income below 133% FPL. Restricted Immigrant Adult Parents/Guardians can not reapply. They are no longer eligible. Parents who have attained Legal Permanent Resident Status for at least five (5) years can apply for coverage as described above.

What if I disagree with the termination from NJ FamilyCare which was based on my immigration status?
You should write to the Department of Medical Assistance and Health Services (DMAHS) Office of Customer Service, P.O. Box 712, Trenton, N.J. 08625-0712, include a copy of any documentation that proves your legal permanent residency of at least five (5) years.