New Jersey FamilyCare Medicaid Income Eligibility Standards 2026

by | Feb 27, 2026 | Legal Bulletin, Medicaid, Medicaid Updates

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services issued Medicaid Communication No. 26-03 on February 26, 2026. The communication updates the income eligibility standards for all NJ FamilyCare programs based on the 2026 Federal Poverty Level (FPL) guidelines, which were published in the Federal Register on January 13, 2026. The new standards are retroactively effective January 1, 2026 for all programs.

Eligibility determining agencies are directed to immediately review any cases denied due to income increases and, where applicable, accrete newly eligible Plan A and ABP cases retroactive to January 1, 2026. Key income standards under the updated chart include:

Medicaid for Adults Aged 19 to 64

  • Single Adults & Parents ABP: $1,836/month for a household of one; $2,489/month for a household of two (see the tables for larger households)

  • Pregnant Women: $2,727/month for a household of one; $3,697/month for a household of two. (see the tables for larger households)

Medicaid and CHIP for Children 18 and younger

  • Medicaid and Children’s Health Insurance Program (CHIP): up to $4,722/month for a household of one; $6402/month for a household of two (see the tables for larger households)

Medicaid for People with a Disability, on Medicare, or Aged 65 and Over

  • SSI Medicaid/Medicaid Only: $1,025.25/month for a single person; $1,516.35/month for a married couple.

  • Aged, Blind, and Disabled (ABD) Medicaid: $1,330/month for a single person; $1,804/month for a married couple.

Long Term Care Medicaid – Managed Long Term Services and Supports (MLTSS)

  • Income Cap: $2,982/month

  • Community Spouse Maintenance Allowance: $2,643.75

  • Housing Allowance: $793.13

  • Utility Allowance: $977.00

  • Community Spouse Resource Allowance: Minimum $32,532; maximum $162,660

  • Maximum Home Equity Limit: $1,130,000

For further context read my posts on ABD Medicaid and SSI Medicaid. For the complete income standards chart covering all NJ FamilyCare programs and household sizes, refer to the full communication here. Practitioners should update their eligibility screening tools to reflect these figures and review any pending or recently denied cases that may now qualify.

New Jersey Expansion of ABD Medicaid Case Numbers

by | Feb 17, 2026 | Legal Bulletin, Medicaid, Medicaid Updates

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services issued Medicaid Communication No. 26-02 on January 2, 2026. The communication advises eligibility determining agencies of an administrative expansion of the case number series used to identify Aged, Blind, and Disabled (ABD) Medicaid recipients. There is no change to benefits or billing practices as a result of this update.

Each NJ FamilyCare enrollee is assigned a unique twelve-digit case number, with the third and fourth digits identifying the recipient's Title XIX Medicaid program. To accommodate the growth in new recipients, the programs identified under series 10, 20, and 50 have been expanded effective November 17, 2025:

  • Aged (Program 10): Expanded to include series 11 and 13.

  • Disabled (Program 20): Expanded to include series 21 and 23.

  • Blind (Program 50): Expanded to include series 51 and 53.

County Social Service Agencies should continue assigning case numbers under the original series (10, 20, and 50) as available. The new expanded numbers are reserved for specific system uses: series 11, 21, and 51 will be generated by the State's claims vendor, Gainwell Technologies, while series 13, 23, and 53 will be generated by the Integrated Eligibility System (IES) Worker Portal through the automated Medicaid Eligibility System (MES) upload.

Practitioners and agency staff who encounter case numbers in the new series should be aware that they reflect the same program definitions and carry the same benefits as the original series. Read the full communication here.

Don’t Let Your Convenience Turn Into a Crisis: Joint Bank Accounts and Medicaid Eligibility in New Jersey

Don’t Let Your Convenience Turn Into a Crisis: Joint Bank Accounts and Medicaid Eligibility in New Jersey

by | Feb 12, 2026 | Medicaid, Medicaid Planning, Power of Attorney

When caring for an aging parent or a disabled loved one, convenience and simplicity is usually the goal, especially when it comes to managing money. Many families find it convenient to add a parent’s name to a college aged child’s account or an adult child’s name to an aging parent’s account, assuming this is a smart way to deposit money and manage bills.

However, in the world of New Jersey Medicaid, this convenience can become a costly crisis. When a loved one needs to apply for Medicaid, that joint account might be the very thing that triggers a denial.

The Rule You Need to Know: N.J.A.C. 10:71-4.1(d)2

New Jersey Medicaid doesn’t view joint accounts the way you do. Their treatment of these funds is governed by N.J.A.C. 10:71-4.1(d)2. The regulation states:

When a savings or checking account is held by the eligible individual with other parties, all funds in the account are resources to the individual so long as he or she has unrestricted access to the funds (that is, an “or” account), regardless of their source. When the individual’s access to the account is restricted (that is, an “and” account), the county welfare agency shall consider a pro rata share of the account toward the appropriate resource maximum, unless the client and the other owner demonstrate that actual ownership of the funds is in a different proportion.

This regulation establishes a harsh default presumption: If your name is on it, you own it.

The impact on eligibility depends entirely on one small word on the bank statement: “or” versus “and.” If an account is titled with “or,” the applicant has “unrestricted access” to the funds. Under the law, 100% of the balance is counted as a resource for the Medicaid applicant. It doesn’t matter if the non-Medicaid applicant deposited every cent of that money. Medicaid assumes the entire balance belongs to the person applying for benefits. If the account is an “and” account that requires both signatures for a withdrawal, Medicaid typically counts a pro rata share (usually 50/50) toward the applicant’s resource limit. While this is slightly better than the “or” scenario, it still places the burden of proof on you to show that the ownership should be divided differently.

With Medicaid resource limits being extremely low, ranging from $2,000 to $6,000 depending on the program and marital status, counting accounts with funds that really don’t belong to the Medicaid applicant can present a real problem.

Can You Fight the Presumption?

Whether the account it titled “and” or “or,” the County social services agency reviewing the Medicaid application will not simply take your word for it. To prove the money doesn’t belong to the applicant, you must provide clear documentary evidence that proves the applicant does not own the money. This includes copies of checks and deposit slips showing where the funds originated as well as a detailed paper trail of how the money was spent. If you can show that all the money coming in and out belonged to and was spent on the non-applicant you may be able to convince the County case handler to disregard the account. Even with solid evidence the County social services agency reviewing the application may still take a hard stance, count the funds toward the resource limit, and deny the application. In sum - rebutting these claims is most often an uphill battle. Absent clear proof, the County will count the funds against the applicant.

The Better Way: Power of Attorney

A joint bank account is not an asset-protection strategy and not a good way to manage an aging or disabled individual’s money. If the goal is to help a loved one manage their income and pay bills, the proper tool is a Power of Attorney (POA). A POA allows you to manage the funds without making those funds yours in the eyes of Medicaid. It provides the same convenience without the massive eligibility risk.

The Bottom Line

Adding a name to an account without legal guidance is a common mistake that creates a mountain of paperwork to undo. Effective Medicaid planning requires understanding how New Jersey actually applies its regulations, rather than relying on assumptions.

Income & Resource Standards for New Jersey Medicaid Only Updated

by | Feb 3, 2026 | Legal Bulletin, Medicaid, Medicaid Updates

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services issued Medicaid Communication No. 26-01 on December 26, 2025. The document includes updates to certain eligibility and post-eligibility calculations, and reflects a 2.8% federal cost-of-living adjustment (COLA) to the SSI eligibility standards.

Notable changes effective January 1, 2026, include:

  • Assisted Living Residence (ALR) and Comprehensive Personal Care Home (CPCH): Monthly room and board rates set at $996.40, with a maintenance needs allowance of $147.65.

  • Adult Family Care (AFC): Monthly room and board rates set at $877.60, with a maintenance needs allowance of $147.65.

  • Community Spouse Resource Allowance: Minimum increased to $32,532; maximum raised to $162,660.

  • MLTSS Income Cap / Living at Home Monthly Standard: Increased to $2,982.

  • In-Kind Support and Maintenance Income Amounts: Updated to $351.33 for an individual and $517.00 for a couple.

For a detailed analysis of In-King Support and Maintenance, read this recent post.

For full details on eligibility calculations, refer to the updated administrative manual sections (N.J.A.C. 10:71-4.8, 5.4-6, and 5.9). Practitioners should be mindful of these changes and update staff to ensure clients receive the most up to date advice. Read the full document here.