The Trump administration has changed some NJ FamilyCare/Medicaid requirements starting January 1, 2027. If you are an adult age 19–64, you may have new requirements to keep your NJ FamilyCare coverage.

Not sure if this applies to you? These changes do not affect everyone. Some people may be excluded because of their age, health, family situation, or other circumstances.

Keep reading to learn what’s changing, whether you may be affected, and what you can do to keep your coverage. This page explains the new requirements, who does not have to meet them, and what steps you can take now.

Beginning January 1, 2027, certain adults ages 19 to 64 who are on NJ FamilyCare Plan ABP (Alternative Benefit Plan) will have to work, volunteer, or go to school to qualify for or keep their NJ FamilyCare coverage. These are officially called community engagement requirements, but they are better known as work requirements. Most of these members will also need to renew their coverage every 6 months instead of every 12 months as they do currently.

If work requirements apply to you, NJ FamilyCare will send you a letter with more information. To find out if you are on NJ FamilyCare Plan ABP, click here to learn how to check your plan type.

NJ FamilyCare may be able to renew your coverage automatically. If NJ FamilyCare needs information from you during your renewal, you will be sent a letter. You should respond quickly to any mail you receive from NJ FamilyCare to help keep your coverage.

No, eligibility will stay the same for most children, NJ FamilyCare Aged Blind Disabled members, and pregnant/postpartum individuals. If this doesn’t describe you, please read on to learn more.

Even if you are on NJ FamilyCare Plan ABP and between the ages of 19 and 64, there are certain health, family, or life situations that may allow you to keep your benefits without completing work requirements. These situations are called “exclusions” and “exceptions.”

You do NOT have to complete work requirements if any of the following describe you right now.

• You DO NOT have to complete requirements if any of the following were true about you at any time since your last renewal::
  • Under 19 years of age
  • Enrolled in Medicare
  • Received Supplemental Security Income (SSI)
  • Received inpatient acute care services, for example, at a hospital, nursing facility, intermediate care facility, or a psychiatric hospital
  • Traveled outside your community to access health care services for yourself or a dependent. This was because that care was not available where you live
  • Lived in a county with high unemployment, as defined by the federal government
  • Lived in an area where the President declared an emergency or disaster
• You MAY NOT have to complete work requirements if you were recently released from jail or prison

A link where you can check your county’s unemployment and disaster status will be posted here when finalized.

New applicants: To be excluded from work requirements (Group 1 above), you must match one of the exclusion groups above either in the month before you apply or in the month you apply. To be excepted (Group 2 above), you must match one of the exception groups in the month before you apply.

Current members: To be excluded or excepted from work requirements (Groups 1 and 2 above), you must match one of the exclusion or exception groups listed above for at least 1 month since your last renewal.

NJ FamilyCare has an online tool in English and Spanish to help you determine if work requirements, exclusions, or exceptions may apply to you. www.njfcchecker.nj.gov

• To be medically frail, you must have a condition that makes it hard for you to complete work requirements. Your condition must also fall into one of these types:
  • Blind or disabled, as defined by the Social Security Administration
  • Substance use disorder. This doesn’t apply if you have been in recovery for 5 or more years
  • Disabling mental health disorder
  • Serious or complex medical condition
  • Significant physical, intellectual, or developmental disability that seriously limits one or more daily activities, such as bathing, dressing, eating, or getting around

NJ FamilyCare verifies whether you are medically frail in two ways:

• Automatic claims check: at renewal, NJ FamilyCare looks at your recent medical records to see if you qualify.
• Medical frailty screener: a short set of questions you answer yourself. You will find it in your application, renewal packet, or letter asking for more information.

NJ FamilyCare is still finalizing the list of conditions that count as medically frail. A link to the full list of conditions will be posted here when finalized.

You can meet work requirements by completing any one of the activities below. You must do one of these activities for at least 1 month since your last renewal, or in the month before a new application:  

• Your household earns at least $580 per month. If your income changes during the year because of seasonal work, such as teaching or landscaping, use your average monthly income for the past 6 months.
• Go to school at least half-time. Your school decides what half-time means.
• Spend at least 80 hours each month doing one or more of these activities:
  • Working
  • Going to school, if you are enrolled less than half-time
  • Participating in a job training program
  • Volunteering or community service

You do not need to meet the requirement every month. As an example, if you lose a job for part of the year, you can keep your coverage if you meet the requirement for at least one month since your last renewal.

What counts as work? Work can be a job for pay, self-employment, owning a business, or contractor work. Some unpaid work counts, too. Community service must be through a public or nonprofit group and help the community. A job training program must be approved by the government, like those run through a state or federal workforce program.

If you are not doing one of the qualifying work requirement activities above, you can start now. If you are already doing one of the activities, start keeping records like pay stubs and timesheets in case you need them for your next renewal. NJ FamilyCare may already have information to verify that you meet work requirements, so you do not need to send documents unless NJ FamilyCare asks for them.

Looking for ways to meet work requirements? Check out these resources:

• NJ Job Source: Search for job openings in New Jersey and find jobs that match your skills and experience
• One-Stop Career Centers: Find a career center near you for in-person help with your job search, career planning, training, and other employment services.
• Job Search Tools and Support: Find help with resumes, job interviews, networking, and other steps you can take to prepare for and find a job
• Education and Training: Find job training, apprenticeships, adult education, and free online learning to help you build new skills
• Workforce Programs: Find programs that can help you build work skills and prepare for a job. Programs are available for adults, young people, veterans, older workers, and people who have lost a job
• Volunteer NJ!: Find volunteer opportunities through local nonprofits and community organizations using this online volunteer-matching platform
• Volunteer Centers of NJ: Find a volunteer center near you to learn more about volunteering options in your community
• AmeriCorps & National Service: Find information on AmeriCorps (a national organization that connects 70,000+ people each year with service opportunities) and other national/community service programs

This website will be updated to include other resources as available.

• Update your contact info: Update your address, phone number, and email so you do not miss important notices. You can do this online here or by calling 1-833-409-2370.
• Watch for letters, emails, or text messages from NJ FamilyCare or your health plan: Respond to letters from NJ FamilyCare as soon as possible.
• Check if the requirements may apply to you: Use the NJ FamilyCare Activity Requirements Checker to help you decide if work requirements apply to you. You can access this tool here.
• Collect and store your documents: Start keeping records that show you meet the work requirements, such as pay stubs or school records. Do not send them now. NJ FamilyCare will send you a letter if you need to provide documents.

NJ FamilyCare can check whether you meet the work requirements in three ways:

• Electronic check: For renewals, NJ FamilyCare automatically checks data it already has, like wage records and other state benefit systems, to see if you still qualify for coverage. If NJ FamilyCare can confirm you are completing work requirements electronically, your coverage will renew on its own. You do not need to do anything.
• Documents: If NJ FamilyCare is missing necessary information from you, you will receive a letter asking you to send documents, like a pay stub or timesheet.
• You tell NJ FamilyCare yourself: For some things that NJ FamilyCare cannot check automatically, like caring for a person with a disability, you can tell NJ FamilyCare about your situation. You can do this on your application, your renewal packet, or in response to a letter asking for more information. This is called “self-attestation,” which is a legal statement, so your answer must be true. Starting January 1, 2028, you may need to send documents as proof.

If your work, school, volunteer, excluded, or excepted status changes, you do not need to tell NJ FamilyCare right away. NJ FamilyCare checks your situation at each renewal. You can tell NJ FamilyCare about changes at your next renewal, such as:

• You start or stop an activity that counts, like starting to volunteer or losing a job
• You become pregnant, or your pregnancy ends (like in a live birth, miscarriage or termination)
• You start or stop regularly caring for a child under age 14, or a person with a disability
• A health condition starts, gets worse, or gets better and changes whether you can meet the requirement
• You have a hospital stay, or you or someone you care for must travel for medical care

Some changes may mean the requirement no longer applies to you, like that you are now excluded or excepted from meeting the work requirement. NJ FamilyCare will look at your situation when you renew. Keep your contact information up to date so you get your renewal packet and other letters.

If something else changes that could affect your Medicaid eligibility, such as your income or the number of people in your household, you must notify NJ FamilyCare within 10 days of the change.

This section gives you options on what to do if your NJ FamilyCare coverage ends. If you receive a termination letter in the mail, it is important to act quickly to have your NJ FamilyCare coverage re-evaluated or to find other health insurance.

Why your coverage can end

If you are supposed to complete work requirements but do not, your coverage can end. Your coverage can also end if you do not respond to mail from NJ FamilyCare, even if you still qualify.

Losing NJ FamilyCare also affects your other coverage options. If you lose your NJ FamilyCare coverage because you do not meet the work requirements, you may still be eligible for coverage from Get Covered NJ, New Jersey’s official health insurance marketplace. However, you will not get financial help to buy a plan.

You have 90 days to send additional information to NJ FamilyCare

If your coverage ended because you did not respond to a letter from NJ FamilyCare, you have 90 days from the day your coverage ends to send NJ FamilyCare the missing information.

• You do not need to fill out a new application. Just send the requested information.
• Send it as soon as you can. If you send NJ FamilyCare information within 60 days from the day your coverage ends, you are less likely to have a gap in your coverage. Do not wait until the last few days before the deadline.
• If NJ FamilyCare determines that you still qualify, your coverage will start again.

You can apply again at any time

You do not have to wait. You can apply for NJ FamilyCare again at any time, even after the 90 days have passed.

You can apply:

• Online at the NJ FamilyCare application website
• By phone at 1-800-701-0710 (TTY: 711)
• In person at your local County Social Service Agency or NJ FamilyCare Regional Office. You can find more information here.

If you think the decision was wrong, you can ask for a fair hearing

If you believe your coverage ended by mistake, you can ask for a fair hearing within 30 days from the date on your termination notice. A fair hearing is a review of your case by someone outside of NJ FamilyCare.

You might ask for a fair hearing if, for example:

• Your coverage ended even though you completed work requirements
• Your coverage ended even though you should have been excluded or excepted
• You sent NJ FamilyCare the requested information on time, but your coverage ended anyway. You believe you still qualify

To ask for a fair hearing, please return the “Your Right to a Fair Hearing” form that was included with your termination letter. The form can be mailed to: Division of Medical Assistance and Health Services, Attn: Fair Hearing Unit, P.O. Box 712, Trenton, NJ 08625

Or, you may fax the form to 609-588-2435. Asking for a fair hearing does not stop you from also sending NJ FamilyCare missing information or applying again. You can do both.

NJ FamilyCare will mail you letters if additional information is needed from you. Many members will be renewed automatically (no action needed) and will not get these letters. If you get mail from NJ FamilyCare, open it right away. You may get these letters:

• NJ FamilyCare Customer Service: 1-800-701-0710 (TTY: 711). Call for help with your application or renewal 
• Hotline for questions: 1-833-409-2370. Call with questions about work requirements, and to update your contact information
• Update your contact information online: Here
• Check if the work requirements apply to you: Here
• Learn more about the federal changes: Here
• Seek help in-person at your local County Social Service Agency or an NJ FamilyCare Regional Office. You can find more information here