Healthcare Assistance for Single Mothers in New Jersey
Healthcare Assistance for Single Mothers in New Jersey: Medicaid, CHIP & More [2025]
Last updated: September 2025
New Jersey has multiple no‑ or low‑cost health coverage paths for you and your kids. This guide gives you the exact income limits, how to apply, phone numbers, timelines, and Plan B options if the first door doesn’t open.
Quick Help Box (read this first)
- Call NJ FamilyCare (Medicaid/CHIP) at 1‑800‑701‑0710 to apply or check status. Live translators are available. Apply online anytime at Apply for NJ FamilyCare (official site). Expect decisions in about 30–45 days. (nj.gov, nj.gov)
- For Marketplace plans and savings, call GetCoveredNJ at 1‑833‑677‑1010. Open Enrollment runs Nov 1 – Jan 31. If your income is up to 200% FPL you may enroll year‑round with “Expanded Access SEP.” Use the state’s Shop & Compare tool. When can I buy coverage? (official). (nj.gov, nj.gov)
- Pregnant? NJ FamilyCare covers you if family income is at or below 205% FPL (e.g., a family of 4 up to $5,493/mo in 2025). Postpartum coverage lasts 12 months. Pregnant women – NJ FamilyCare (official). (nj.gov)
- Kids under 19 are covered up to 355% FPL (a family of 4 up to $9,512/mo in 2025). Immigration status does not matter. Premiums for kids were eliminated. Apply via Cover All Kids. (nj.gov)
- Hospital bill you can’t pay? Ask the hospital for “Charity Care.” Free care if income ≤ 200% FPL; discounted up to 300% FPL. Apply at the hospital. Charity Care program (official). (casetext.com, nj.gov)
- Need a ride to appointments on NJ FamilyCare? Call Modivcare at 1‑866‑527‑9933 (book ≥2 days ahead). NJ Medicaid Transportation (official). (nj.gov)
- Crisis or mental health help now: Call or text 988 (24/7). NJ also offers NJMentalHealthCares 866‑202‑4357 and the Postpartum line 1‑800‑328‑3838. (nj.gov)
Why this guide beats the usual results
We reviewed the top search results for “New Jersey Healthcare Assistance for Single Mothers.” Most were either (a) generic national lists, (b) outdated 2024 figures, or (c) missing key NJ‑specific programs like Emergency Medicaid (MEPP), Charity Care income tiers, Modivcare ride numbers, postpartum 12‑month coverage, Cover All Kids immigration rules, and real application timelines. This guide fills those gaps with 2025‑verified numbers, direct links, and phone contacts, plus “Plan B” options for when applications get stuck. Sources are always official state or federal sites, or established statewide nonprofits with legal/benefits expertise.
Quick Reference Cheat Sheet
| What you need | Where to go | Core rule/limit | How to apply / phone |
|---|---|---|---|
| NJ FamilyCare (Medicaid/CHIP) | NJ Dept. of Human Services | Adults ≤ 138% FPL; Pregnant ≤ 205% FPL; Kids ≤ 355% FPL | Apply online or call 1‑800‑701‑0710. Decision ~30–45 days. (nj.gov, nj.gov) |
| GetCoveredNJ (Marketplace) | NJ Dept. of Banking & Insurance | Open Enrollment Nov 1 – Jan 31; Expanded Access SEP up to 200% FPL; State subsidies up to 600% FPL | Shop/compare or call 1‑833‑677‑1010. When can I buy? (nj.gov, nj.gov) |
| Hospital Charity Care | NJ Dept. of Health | Free at ≤ 200% FPL; sliding discount to 300% FPL | Apply at the hospital; program line 1‑866‑588‑5696. (casetext.com, nj.gov) |
| Emergency Medicaid (MEPP) | NJ FamilyCare | Emergency services for those not meeting immigration rules; pregnant up to 199% FPL, adults up to 138% FPL | Apply at hospital or county within 3 months of emergency. (nj.gov) |
| Rides to care (NEMT) | Modivcare | NJ FamilyCare members | Book at 1‑866‑527‑9933 (2+ days ahead). (nj.gov) |
| Kids’ behavioral health | PerformCare/DCF | 24/7 access line for youth | 1‑877‑652‑7624; mobile response available. (performcarenj.org) |
| FQHCs (low‑cost clinics) | HRSA | Sliding‑fee primary care | Find a clinic near you: Find a Health Center (official). (data.hrsa.gov) |
NJ FamilyCare (Medicaid/CHIP): who qualifies, how to apply, what’s covered
Start here (fastest path)
- Apply online at NJ FamilyCare – official application. Or call 1‑800‑701‑0710 (TTY 711) to apply by phone or get live language help. (nj.gov)
- Expect a decision in about 30–45 days. You’ll get a letter either way. (nj.gov)
- Most members enroll in a managed care plan (MCO). You can pick a plan during the application. If you need to change later, call the NJ FamilyCare enrollment broker at 1‑866‑472‑5338 (TTY 1‑800‑701‑0720). (nj.gov)
- Need care before approval? Ask a clinic or hospital about Presumptive Eligibility (PE); many providers can pre‑approve short‑term coverage while your full application is processed. (nj.gov)
2025 income limits (adults, kids, pregnant)
The table below uses the official 2025 HHS Federal Poverty Guidelines and NJ FamilyCare rules for each group. Annual FPL is converted to monthly by dividing by 12. Where NJ posts specific 2025 monthly examples, we show the state figure. (aspe.hhs.gov, nj.gov)
| Household | Adults 19–64 (≤138% FPL) | Pregnant (≤205% FPL) | Children <19 (≤355% FPL) |
|---|---|---|---|
| 1 | ≤ 21,597/yr∗∗(≈∗∗21,597/yr** (≈ **1,800/mo) | ≤ 32,083/yr∗∗(≈∗∗32,083/yr** (≈ **2,674/mo) | ≤ 55,558/yr∗∗(≈∗∗55,558/yr** (≈ **4,630/mo) |
| 2 | ≤ 29,187/yr∗∗(≈∗∗29,187/yr** (≈ **2,432/mo) | ≤ 43,358/yr∗∗(≈∗∗43,358/yr** (≈ **3,613/mo) | ≤ 75,083/yr∗∗(≈∗∗75,083/yr** (≈ **6,257/mo) |
| 3 | ≤ 36,777/yr∗∗(≈∗∗36,777/yr** (≈ **3,065/mo) | ≤ 54,633/yr∗∗(≈∗∗54,633/yr** (≈ **4,553/mo) | ≤ 94,608/yr∗∗(≈∗∗94,608/yr** (≈ **7,884/mo) |
| 4 | ≤ 44,367/yr∗∗(≈∗∗44,367/yr** (≈ **3,698/mo state example $3,698) | ≤ 65,908/yr∗∗(≈∗∗65,908/yr** (≈ **5,493/mo state example $5,493) | ≤ 114,133/yr∗∗(≈∗∗114,133/yr** (≈ **9,512/mo state example $9,512) |
Notes:
- Adults ≤138% FPL example: “single person 1,800/mo∗∗;familyof4∗∗1,800/mo**; family of 4 **3,698/mo” published by NJ DHS for 2025. (nj.gov)
- Pregnant ≤205% FPL example: family of 4 $5,493/mo (2025). NJ provides 12 months postpartum coverage. (nj.gov)
- Children ≤355% FPL example: family of 4 $9,512/mo (2025). Immigration status does not affect eligibility; premiums for children were eliminated under Cover All Kids. (nj.gov)
What NJ FamilyCare covers
- Primary care, specialists, hospital care, pregnancy care, behavioral health, prescriptions, pediatric dental/vision, and more. Most members are in MCOs. (nj.gov)
- Transportation to covered appointments (non‑emergency): call Modivcare at 1‑866‑527‑9933 at least 2 business days before. “Where’s my ride?” 1‑866‑527‑9934. Facility line 1‑866‑527‑9945. Complaints 1‑866‑333‑1735. (nj.gov)
- Autism services (children): dedicated NJ Medicaid Autism helpline (609) 588‑8522 and benefit guides available. (nj.gov)
- For 12 months after birth, pregnant members stay covered even if income changes (postpartum extension). Babies can have NJ FamilyCare to their first birthday. (nj.gov)
How to apply (documents + steps)
Bring or upload:
- Proof of NJ address, names and birthdates, pregnancy due date (if pregnant). (nj.gov)
- Social Security numbers (if you have them), immigration status for anyone applying, and income details (recent pay stubs, employer letter, or self‑employment Profit & Loss). (nj.gov)
- Pick an MCO whose doctors you use. You can change later if needed. (nj.gov)
You can apply:
- Online at NJ FamilyCare – official, by phone 1‑800‑701‑0710, or in person at your County Board of Social Services (directory on the state site). (nj.gov, nj.gov)
Timeline tips:
- Standard processing: 30–45 days. Check your online account for updates and open every letter. (nj.gov)
- If you need care now: ask about Presumptive Eligibility (PE) at your clinic/hospital. (nj.gov)
- Renewal: watch mail/texts. If you get a renewal packet, complete it by the deadline to avoid a gap. (nj.gov)
Picking or changing your managed care plan (MCO)
New Jersey’s NJ FamilyCare MCOs (2025): Aetna Better Health of NJ, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, Wellpoint (formerly Amerigroup). To enroll/change, call 1‑866‑472‑5338 (TTY 1‑800‑701‑0720). (nj.gov)
Member services phone numbers (quick look):
| Plan | Member Services |
|---|---|
| Aetna Better Health of NJ | 1‑855‑232‑3596 |
| Wellpoint (Amerigroup) | 1‑800‑600‑4441 |
| Horizon NJ Health | 1‑800‑682‑9090 |
| UnitedHealthcare Community Plan | 1‑800‑941‑4647 |
| WellCare | 1‑888‑453‑2534 |
Source: NJ state “Help Navigating Your Health Plan Benefits” hub. Use the number on your ID card if different. (nj.gov)
If you prefer in‑state help lines by region (MACCs):
- Atlantic/Burlington/Camden/Cape May/Cumberland/Gloucester/Mercer/Salem: 1‑856‑209‑0520
- Bergen/Passaic/Morris/Sussex/Warren: 1‑862‑338‑9890
- Essex/Hudson: 1‑862‑682‑4430
- Monmouth/Ocean/Middlesex/Hunterdon/Somerset/Union: 1‑908‑430‑0231 (nj.gov)
Real‑world example
You earn 3,400/mo∗∗andcarefortwokids(householdof3).That’sunderthe1383,400/mo** and care for two kids (household of 3). That’s under the 138% adult limit (**3,065/mo for 3) and far under kids’ 355% limit. You can enroll yourself and each child in NJ FamilyCare. If you’re pregnant, the 205% limit ($4,553/mo for 3) applies. (aspe.hhs.gov)
What to do if this doesn’t work (Plan B)
- If denied for income, but you lost hours last month, appeal or reapply with current pay stubs. Monthly MAGI matters.
- If you get a termination letter, request a fair hearing within 60 days and keep your docs handy. (nj.gov)
- If a service is denied by your health plan, file a Stage 1 appeal quickly (for NJ FamilyCare you generally have 60 days), then Stage 2, then an external appeal via IHCAP if needed. (nj.gov)
- If you can’t reach the call center, call your regional MACC (above) or your MCO’s Member Services.
GetCoveredNJ (Marketplace plans) — when NJ FamilyCare isn’t an option
Start here
- Shop plans, check savings, and enroll at GetCoveredNJ (official). Phone help: 1‑833‑677‑1010. Open Enrollment is Nov 1 – Jan 31. (nj.gov)
- Expanded Access Special Enrollment: Income up to 200% FPL (2025 examples: 30,120∗∗for1;∗∗30,120** for 1; **62,400 for 4) lets you enroll year‑round in nearly‑free plans. (nj.gov, nj.gov)
- State subsidies (NJ Health Plan Savings) stack on top of federal APTC up to 600% FPL (2025: 90,360∗∗for1;∗∗90,360** for 1; **187,200 for 4). (nj.gov)
- 2025 caps: insulin 35/month∗∗,EpiPens∗∗35/month**, EpiPens **25/month, asthma inhalers $50/month on all GetCoveredNJ plans. (nj.gov)
- Cost‑Sharing Reductions: If income is 138%–250% FPL, choose a Silver plan to get lower deductibles and copays. (nj.gov)
What to expect
- Enroll by Dec 31 → coverage starts Jan 1. Enroll in January → starts Feb 1. Outside Open Enrollment, you need a qualifying life event unless you meet the Expanded Access SEP income rule above. (nj.gov)
- Free local help: Navigators statewide offer one‑on‑one help. Use “Find Local Assistance” on the site. (nj.gov)
What to do if this doesn’t work
- If your Marketplace application says you likely qualify for NJ FamilyCare, follow through; don’t ignore it. The Marketplace sends your case to NJ FamilyCare. (nj.gov)
- If you missed Open Enrollment and don’t qualify for SEP, see FQHCs below for sliding‑fee care, or Charity Care for hospital bills.
New Jersey Hospital Charity Care (Hospital Care Payment Assistance Program)
If a hospital bill is staring you down, don’t panic—ask the hospital’s financial assistance office for a Charity Care application.
- Who qualifies: NJ residents with medically necessary acute‑care hospital services and limited income/assets. Program is free at ≤ 200% FPL and discounted up to 300% FPL. You pay a percentage of the Medicare‑adjusted hospital charges based on income. Apply at the hospital where you received care. (nj.gov, lsnjlaw.org)
- Discount table (what you pay):
| Income (as % of FPL) | You pay this % of charges |
|---|---|
| ≤200% | 0% (free) |
| >200%–225% | 20% |
| >225%–250% | 40% |
| >250%–275% | 60% |
| >275%–300% | 80% |
| >300% | 100% (no discount) |
Regulatory basis: N.J.A.C. 10:52‑11.8 (codified policy). (casetext.com)
- Get help: Charity Care program line 1‑866‑588‑5696 (Mon–Fri). (nj.gov)
- Tip: Even if you have insurance but a big balance, ask the hospital to apply the discount to the remaining Medicare‑adjusted amount (explained by Legal Services of NJ). (lsnjlaw.org)
What to do if this doesn’t work
- If you’re denied, ask in writing for the specific reason and what proof they need. Reapply with missing docs. If you believe the denial is wrong, contact Legal Services of NJ at 1‑888‑576‑5529 for free legal help. (lsnjlaw.org)
Emergency Medicaid (MEPP) — for emergencies and labor/delivery if you can’t get NJ FamilyCare
- What it covers: Emergency treatment at an acute‑care hospital (including labor/delivery).
- Who qualifies: NJ residents who meet the program’s income rules but don’t meet citizenship/immigration requirements. 2025 income rules: pregnant up to 199% FPL (family of 4 5,332/mo∗∗),adults19–64upto∗∗1385,332/mo**), adults 19–64 up to **138% FPL** (family of 4 **3,698/mo). Seniors/people with disabilities have separate income/resource limits (e.g., single income 1,305/mo∗∗,resources∗∗1,305/mo**, resources **4,000). (nj.gov)
- How to apply: Hospital staff can file for you, or you can apply at your County Social Services Agency within 3 months of the emergency. If your labor/delivery wasn’t at a hospital, you must have itemized bills. (nj.gov)
- Prenatal care while waiting: Ask providers about the New Jersey Supplemental Prenatal & Contraceptive Program (NJSPCP) for prenatal and family planning visits and doula services if you meet income rules (immigration status not required). “Plan First” offers limited family planning benefits up to 205% FPL. (nj.gov)
What to do if this doesn’t work
- If MEPP doesn’t cover non‑emergency clinic bills, use an FQHC (below) and ask about the sliding fee scale. Use Charity Care to reduce any hospital bills.
Low‑cost clinics (FQHCs) and dental options
- Federally Qualified Health Centers (FQHCs) provide primary care, women’s health, pediatric care, behavioral health, and dental—on a sliding fee scale. Find clinics statewide using the official HRSA locator. (data.hrsa.gov)
- NJ has a statewide FQHC network (23 organizations operating 130+ sites). Use the NJ Primary Care Association’s “Locate a Health Center” map if you prefer a state directory. (njpca.org)
- Dental: NJ FamilyCare covers many dental services; FQHCs often provide low‑cost dental if you’re uninsured. For rides to dental visits on NJ FamilyCare, use Modivcare (numbers above). (nj.gov)
What to do if this doesn’t work
- Call 2‑1‑1 to look for a free/low‑cost clinic in your county if you can’t find an FQHC appointment soon enough. (NJ 2‑1‑1 is the state’s referral line.) (nj.gov)
Mental health, postpartum, and kids’ behavioral health
- 24/7 crisis: 988 Suicide & Crisis Lifeline. Mobile Crisis Outreach Response Teams (MCORTs) are now operating in NJ and can be dispatched via 988 for non‑life‑threatening adult crises. (nj.gov)
- NJMentalHealthCares information & referral: 866‑202‑4357 (8am–8pm). NJ Hopeline: 1‑855‑654‑6735 (24/7). (nj.gov)
- Postpartum mental health: NJ Family Healthline 1‑800‑328‑3838 (Mon–Fri 8am–6pm). (nj.gov)
- Moms of kids with special needs: Mom2Mom peer support 1‑877‑914‑6662 (with clinical backup). (nj.gov)
- For children and teens (up to 21): PerformCare access line 1‑877‑652‑7624 (24/7). They can even send Mobile Response to your home within about an hour to stabilize a situation, then connect you to services. (performcarenj.org)
What to do if this doesn’t work
- If you can’t get an MCO appointment fast enough, call your plan’s Member Services (see table) and ask for “expedited access” due to urgent need. If still blocked, call NJDOBI for managed‑care complaints at 1‑888‑393‑1062. (nj.gov)
Transportation to care (NJ FamilyCare)
- Book non‑emergency rides with Modivcare. Call 1‑866‑527‑9933 at least two business days ahead; use 1‑866‑527‑9934 for “Where’s my ride?” and 1‑866‑333‑1735 for complaints. Have your HBID and appointment info ready. (nj.gov)
What to do if this doesn’t work
- If you miss an appointment because the ride never came, call your provider to reschedule and document it. Report the no‑show to Modivcare (complaint line above). If problems persist, call your MCO’s Member Services.
Common mistakes to avoid
- Sending partial pay‑stub sets (e.g., only 1 of 4 weekly stubs). Upload the full month.
- Not opening mail from “State of New Jersey” or your MCO—many denials happen because people miss a simple request for proof. (nj.gov)
- Choosing an MCO your current doctors don’t take. Confirm your doctors first, then pick (you can switch later if needed). (nj.gov)
- Forgetting to report the baby’s birth to NJ FamilyCare so the baby’s coverage starts right away. (nj.gov)
- Waiting until bills go to collections before asking the hospital about Charity Care. Apply early at the hospital billing office. (nj.gov)
Application checklist (what to gather)
- NJ address (residence and mailing if different); names/birthdates for everyone applying; pregnancy proof with due date if pregnant.
- Social Security numbers (if you have them). You can still apply if you don’t.
- Immigration documentation for those applying.
- Income: employer name/address, how often paid, gross pay; other income (unemployment, SSI).
- Your preferred MCO (call your clinic to ask which plans they take).
- Create an online account so you can check status and upload documents. (nj.gov)
Timelines and what to expect
| Item | Typical timing |
|---|---|
| NJ FamilyCare decision | 30–45 days; letters by mail. (nj.gov) |
| GetCoveredNJ Open Enrollment | Nov 1 – Jan 31; Expanded Access SEP year‑round ≤200% FPL. (nj.gov, nj.gov) |
| Marketplace QLE SEP window | Usually 60 days after the event. (nj.gov) |
| MEPP application window | Apply within 3 months after the emergency. (nj.gov) |
| Modivcare ride booking | Book ≥2 business days before the visit. (nj.gov) |
Appeals, complaints, and help if you’re stuck
- NJ FamilyCare termination or adverse action: request a state fair hearing within 60 days of the notice. (nj.gov)
- Denied service by an MCO (utilization management): Stage 1 appeal, then Stage 2, then Independent Health Care Appeals Program (IHCAP). Medicaid members generally have 60 days to file Stage 1 and 60 days to file with IHCAP. (nj.gov)
- Managed care complaint (network/access issues): file with your plan and with NJDOBI Office of Managed Care (1‑888‑393‑1062). (nj.gov)
- General Medicaid questions: NJ Medicaid Hotline 1‑800‑356‑1561 (TTY 1‑800‑701‑0720). (nj.gov)
Diverse communities: targeted pointers
- LGBTQ+ single mothers: FQHCs are welcoming, have interpreters, and offer inclusive care; use the HRSA locator to find nearby clinics and filter by services. For mental health, 988 can route you to affirming support. (data.hrsa.gov, nj.gov)
- Single mothers with disabilities or caring for disabled children: Call PerformCare 1‑877‑652‑7624 for behavioral or developmental services for youth; ask about Mobile Response. For Early Intervention (birth–3), call 1‑888‑653‑4463 to start an evaluation; families below 300% FPL have no EI cost participation. (performcarenj.org, nj.gov, nj.gov)
- Veteran single mothers: Marketplace and NJ FamilyCare coverage can coordinate with VA care if needed; use GetCoveredNJ for plan help and NJ FamilyCare if you meet income rules. (nj.gov, nj.gov)
- Immigrant/refugee single moms: Kids under 19 can get NJ FamilyCare regardless of immigration status if the household meets income rules; pregnant individuals may qualify for NJ FamilyCare if lawfully present, and for NJSPCP/MEPP otherwise. Live interpreters are available at 1‑800‑701‑0710. (nj.gov)
- Tribal citizens/AIAN: If shopping on GetCoveredNJ, you may get enhanced cost‑sharing protections; you can still use NJ FamilyCare if income‑eligible. Check plan details and use local FQHCs if you prefer IHS‑like community services. (nj.gov)
- Rural single moms and those with limited transportation: Use Modivcare for rides if you’re on NJ FamilyCare; if uninsured, find the closest FQHC and ask about telehealth options and sliding fees. (nj.gov, data.hrsa.gov)
- Single fathers and kin caregivers: All programs above apply to eligible caregivers. PerformCare and NJ FamilyCare are household‑based; the applying adult can be a parent, relative, or caregiver. (nj.gov)
- Language access: NJ FamilyCare provides interpreter services. Call 1‑800‑701‑0710 and ask for live translation. Cover All Kids FAQs confirm language help. (nj.gov)
Local organizations and hotlines worth saving
- NJ 2‑1‑1: statewide referrals for clinics, mental health, housing, and more—dial 2‑1‑1. (nj.gov)
- Legal Services of New Jersey (health/Charity Care help): 1‑888‑576‑5529. (lsnjlaw.org)
- PerformCare (children/youth): 1‑877‑652‑7624. (performcarenj.org)
- NJMentalHealthCares: 866‑202‑4357; 988 for crisis. (nj.gov)
- Early Intervention System (birth–3): 1‑888‑653‑4463. (nj.gov)
- Charity Care program line: 1‑866‑588‑5696. (nj.gov)
- GetCoveredNJ Customer Center: 1‑833‑677‑1010. (nj.gov)
Tables you can screenshot
1) NJ FamilyCare 2025 income limits by group (annual and monthly)
| Group | 1 person | 2 people | 3 people | 4 people |
|---|---|---|---|---|
| Adults ≤138% FPL | 21,597/yr∗∗(≈∗∗21,597/yr** (≈ **1,800/mo) | 29,187/yr∗∗(≈∗∗29,187/yr** (≈ **2,432/mo) | 36,777/yr∗∗(≈∗∗36,777/yr** (≈ **3,065/mo) | 44,367/yr∗∗(≈∗∗44,367/yr** (≈ **3,698/mo) |
| Pregnant ≤205% FPL | 32,083/yr∗∗(≈∗∗32,083/yr** (≈ **2,674/mo) | 43,358/yr∗∗(≈∗∗43,358/yr** (≈ **3,613/mo) | 54,633/yr∗∗(≈∗∗54,633/yr** (≈ **4,553/mo) | 65,908/yr∗∗(≈∗∗65,908/yr** (≈ **5,493/mo) |
| Children ≤355% FPL | 55,558/yr∗∗(≈∗∗55,558/yr** (≈ **4,630/mo) | 75,083/yr∗∗(≈∗∗75,083/yr** (≈ **6,257/mo) | 94,608/yr∗∗(≈∗∗94,608/yr** (≈ **7,884/mo) | 114,133/yr∗∗(≈∗∗114,133/yr** (≈ **9,512/mo) |
Based on 2025 HHS poverty guidelines and NJ DHS category rules. (aspe.hhs.gov, nj.gov)
2) GetCoveredNJ fast facts (2025)
| Item | 2025 |
|---|---|
| Open Enrollment | Nov 1 – Jan 31 |
| Year‑round SEP (income) | Up to 200% FPL (e.g., 30,120∗∗for1;∗∗30,120** for 1; **62,400 for 4) |
| State subsidies | Up to 600% FPL (90,360∗∗for1;∗∗90,360** for 1; **187,200 for 4) |
| Insulin/EpiPen/Inhaler caps | 35/35 / 25 / $50 per month |
Sources: GetCoveredNJ and NJDOBI (state). (nj.gov, nj.gov)
3) Hospital Charity Care – what you pay
| Income vs FPL | You pay |
|---|---|
| ≤200% | 0% |
| >200–225% | 20% |
| >225–250% | 40% |
| >250–275% | 60% |
| >275–300% | 80% |
Reg: N.J.A.C. 10:52‑11.8. Apply at the hospital. (casetext.com, nj.gov)
4) Key phone numbers (save this)
| Service | Number |
|---|---|
| NJ FamilyCare (apply/status) | 1‑800‑701‑0710 |
| Medicaid Hotline | 1‑800‑356‑1561 |
| GetCoveredNJ | 1‑833‑677‑1010 |
| Modivcare (rides) | 1‑866‑527‑9933 |
| PerformCare (kids) | 1‑877‑652‑7624 |
| Charity Care program | 1‑866‑588‑5696 |
| 988 Suicide & Crisis | 988 |
| NJMentalHealthCares | 866‑202‑4357 |
Sources: NJ DHS, NJDOBI, NJ DOH. (nj.gov, nj.gov, performcarenj.org)
5) NJ FamilyCare MCOs – member services
| MCO | Phone |
|---|---|
| Aetna Better Health of NJ | 1‑855‑232‑3596 |
| Wellpoint (Amerigroup) | 1‑800‑600‑4441 |
| Horizon NJ Health | 1‑800‑682‑9090 |
| UnitedHealthcare Community Plan | 1‑800‑941‑4647 |
| WellCare | 1‑888‑453‑2534 |
Source: NJ state consumer page. (nj.gov)
6) Regional help (MACCs)
| Region | Phone |
|---|---|
| South/Central (Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Salem) | 1‑856‑209‑0520 |
| North‑West (Bergen, Passaic, Morris, Sussex, Warren) | 1‑862‑338‑9890 |
| Essex/Hudson | 1‑862‑682‑4430 |
| Shore/Central (Monmouth, Ocean, Middlesex, Hunterdon, Somerset, Union) | 1‑908‑430‑0231 |
Source: NJ state “Help Navigating Your Health Plan Benefits.” (nj.gov)
Real‑world “what if” scenarios
- I make 3,900/mo∗∗with2kidsandI’mnotpregnant.Adults’limitfor3isabout∗∗3,900/mo** with 2 kids and I’m not pregnant. Adults’ limit for 3 is about **3,065/mo, so I may not qualify as an adult, but my children are still eligible up to 355% FPL. I can cover myself via GetCoveredNJ (with state/federal subsidies) and keep the kids on NJ FamilyCare. (aspe.hhs.gov)
- I’m undocumented and pregnant. My prenatal visits can be covered under NJSPCP if I meet income rules; labor/delivery can be covered under MEPP (apply within 3 months if hospital doesn’t file). After birth, talk with a Navigator to keep the baby continuously covered. (nj.gov)
- My plan denied an MRI. I file a Stage 1 appeal with my MCO (Medicaid members generally have 60 days), then Stage 2 if needed, then an IHCAP external appeal if it’s still denied. (nj.gov)
What the top pages don’t tell you (reality checks, tips)
- Keep copies of every document you upload and every letter you get. Many denials are just missing proof.
- Switching MCOs is allowed. If your doctors aren’t in network, call the enrollment broker at 1‑866‑472‑5338. (nj.gov)
- Kids have 12‑month continuous coverage under federal rules; report moves, births, and your new income—but don’t skip care because of a temporary income change. (nj.gov)
- Marketplace savings can be large. In 2025, the Governor reported average assistance of $589/person/month for those who qualify. Use the state tool to see your price. (nj.gov)
Frequently Asked Questions (New Jersey‑specific)
- How fast can I get covered if I’m pregnant?
- If eligible, NJ FamilyCare covers pregnancy and then 12 months postpartum. Ask a clinic about Presumptive Eligibility to start care right away. (nj.gov)
- Are there premiums for children on NJ FamilyCare?
- No. NJ eliminated CHIP premiums under the Cover All Kids initiative. (nj.gov)
- Can my child get NJ FamilyCare if we’re undocumented?
- Yes, if income‑eligible and under 19. Immigration status does not affect a child’s eligibility. (nj.gov)
- How do I get a ride to medical visits?
- If you’re on NJ FamilyCare, call Modivcare 1‑866‑527‑9933 at least 2 business days before the appointment. (nj.gov)
- What if I missed Open Enrollment?
- If your income is at or below 200% FPL, you can enroll year‑round through GetCoveredNJ (Expanded Access SEP). Otherwise, you’ll need a qualifying life event or wait until Nov 1. (nj.gov)
- Where can I get low‑cost care if I’m uninsured?
- Use an FQHC via the HRSA “Find a Health Center” tool; they use sliding fees. (data.hrsa.gov)
- My hospital bill is huge. Can Charity Care still help?
- Yes. If income ≤ 200% FPL it may be free; up to 300% you’ll pay a reduced percentage. Apply at the hospital where you were treated. (casetext.com)
- I was denied a service by my plan. What are my rights?
- You can appeal internally (Stage 1, then Stage 2) and, if needed, use the Independent Health Care Appeals Program (IHCAP). Medicaid members generally have 60 days to appeal. (nj.gov)
- How do I replace a lost NJ FamilyCare ID card?
- Call the HBID unit at 1‑877‑414‑9251. (nj.gov)
- Who can help me in person?
- Use a county Board of Social Services (state directory), or call regional MACCs (see table) for Medicaid help. For Marketplace help, use the “Find Local Assistance” tool. (nj.gov)
What to do if nothing seems to work
- Call your regional MACC (see table) or the Medicaid Hotline 1‑800‑356‑1561. (nj.gov)
- For unresolved plan issues, file a complaint with NJDOBI and consider the IHCAP external appeal if a covered service keeps getting denied. (nj.gov, nj.gov)
- If you’re overwhelmed, find a Navigator on GetCoveredNJ or call 2‑1‑1 for a warm handoff to local help. (nj.gov, nj.gov)
About This Guide
Compiled by the ASingleMother.org Editorial Team
This guide uses official sources from the New Jersey Department of Human Services, New Jersey Department of Health, New Jersey Department of Banking & Insurance, HHS/HRSA, and established statewide nonprofits (e.g., Legal Services of New Jersey). It is produced under our Editorial Standards—we cite only official or established sources, test links at publication, and update quickly when policies change. We are independent researchers, not a government agency. Individual eligibility outcomes cannot be guaranteed. Last verified September 2025, next review April 2026.
Disclaimer
- Program rules, dollar amounts, and timelines can change. Always verify details with the relevant agency or plan. We link to official pages so you can check the latest.
- Health content here is general information, not medical or legal advice.
- Site security note: we do not request or store your personal health information. For your privacy, never post SSNs, case numbers, or medical details in public forums. If you email documents to an agency, use only the official email or upload portals linked in this guide.
Sources (selected)
- 2025 Federal Poverty Guidelines (HHS ASPE). (aspe.hhs.gov)
- NJ FamilyCare adults 2025 examples; programs and coverage; MCO info. (nj.gov)
- Pregnant eligibility 205% FPL (2025), postpartum 12 months. (nj.gov)
- Children up to 355% FPL; Cover All Kids (no premiums, immigration‑neutral). (nj.gov)
- GetCoveredNJ enrollment windows, SEP at ≤200% FPL; state subsidies up to 600% FPL; 2025 drug caps. (nj.gov, nj.gov)
- Charity Care rules (N.J.A.C. 10:52‑11.8) and public program pages. (casetext.com, nj.gov)
- Emergency Medicaid (MEPP) income limits and application window. (nj.gov)
- Modivcare ride numbers and rules. (nj.gov)
- Behavioral health hotlines (988/MCORTs, NJMentalHealthCares, NJ Hopeline) and perinatal supports (Family Healthline). (nj.gov)
- PerformCare (children’s behavioral health) access line. (performcarenj.org)
- FQHC locator (HRSA) and NJPCA directory. (data.hrsa.gov, njpca.org)
- Appeals/complaints (NJDOBI IHCAP and managed‑care complaint process). (nj.gov)
If you spot an error or a broken link, email info@asinglemother.org. We review urgent corrections within 24–48 hours per our Editorial Policy.
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