by Jose D. Roman | Mar 1, 2026 | Consumer Advocacy, Legal Bulletin, Medicaid, Medicaid Updates
As a New Jersey Medicaid lawyer, I’m often asked whether immigrants—especially those who are undocumented—can qualify for Medicaid or other forms of public health coverage. The answer is complicated, because eligibility depends on a mix of federal law, state initiatives, and funding streams that shift with each legislative cycle. The short answer is that New Jersey offers more inclusive health coverage than most states, but many immigrants still face limits depending on their immigration status.
Lawfully Present vs. Undocumented: A Crucial Distinction
Federal Medicaid law draws a sharp line between immigrants who are “lawfully present” and those who are “undocumented.” Lawfully present immigrants include lawful permanent residents (green card holders), refugees, asylees, victims of trafficking, certain humanitarian parolees, and others permitted to live in the U.S. under federal immigration law.
Many of these immigrants can qualify for Medicaid, though most must first wait five years after obtaining status before they become eligible. Historically, refugees, asylees, and trafficking victims were exempt from that five-year bar and could access coverage immediately. As explained below, the One Big Beautiful Bill Act (OBBBA) has significantly changed this going forward, with major provisions taking effect October 1, 2026.
By contrast, undocumented immigrants—those without lawful status—cannot enroll in full Medicaid coverage under federal law. But in New Jersey, there are exceptions and state-funded programs that fill some of the gaps.
New Jersey’s State Initiatives: Expanding Coverage for Children and Families
One of the most significant New Jersey state programs is Cover All Kids. Enacted into law in 2021, the program was implemented in phases, with full coverage for undocumented children taking effect on January 1, 2023, under Governor Murphy’s administration. It allows all children under 19 to receive NJ FamilyCare coverage regardless of immigration status, as long as they meet the income and residency rules. It is a groundbreaking policy that recognizes every child’s need for health care, no matter where they were born. It’s important to understand how it’s funded. Because federal Medicaid and Children’s Health Insurance Program (CHIP) funds cannot be used for undocumented children, Cover All Kids is paid for entirely by New Jersey.
New Jersey also provides coverage for pregnant women, though the scope depends on immigration status. U.S. citizens and lawfully present immigrants with low are eligible for full NJ FamilyCare/Medicaid coverage during pregnancy, with postpartum coverage continuing for 12 months after delivery. Undocumented women who do not qualify for full Medicaid may be eligible for the NJ Supplemental Prenatal and Contraceptive Program (NJSPCP), which covers outpatient prenatal and family planning services. Emergency labor and delivery for undocumented women may be covered separately under Emergency Medicaid, described below.
Emergency Coverage for All
Even for those who don’t qualify for Medicaid benefits, emergency medical care remains available. Through the Medical Emergency Payment Program (commonly called Emergency Medicaid), immigrants—regardless of status—can receive coverage for treatment of life-threatening conditions, including labor and delivery.
This program is not purely state-funded. Federal law allows states to receive federal Medicaid matching funds for emergency services provided to individuals who are otherwise Medicaid-eligible but not lawfully present. New Jersey is a Medicaid expansion state, meaning it currently receives approximately 90% federal reimbursement for these emergency services, with the state covering the remainder. Hospitals remain legally required under the federal Emergency Medical Treatment and Labor Act to provide emergency stabilization to any patient regardless of immigration status or ability to pay. Only true emergencies qualify for Emergency Medicaid; any non-emergency care for undocumented immigrants must be fully funded by the state if offered at all.
The “One Big Beautiful Bill” and Its Sweeping Impact on Immigrant Coverage
The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, makes the most far-reaching changes to immigrant Medicaid eligibility since the 1996 welfare reform law. While much public attention has focused on work requirements and hospital reimbursements, the OBBBA’s effects on immigrant health coverage are equally significant.
The key changes for New Jersey residents are:
- Refugees, asylees, humanitarian parolees, and trafficking victims lose federal Medicaid and CHIP eligibility entirely (effective October 1, 2026). Under prior law, these groups were exempt from the five-year waiting period and could access Medicaid immediately upon receiving status. Under the OBBBA, they are removed from the definition of “qualified alien” for Medicaid purposes altogether. Only green card holders (lawful permanent residents), certain Cuban and Haitian entrants, and citizens of Freely Associated States remain eligible for federal Medicaid. States may still choose to cover lawfully residing children and pregnant women using their own funds.
- Emergency Medicaid federal reimbursement is reduced (effective October 1, 2026). For undocumented immigrants who would otherwise be Medicaid-eligible, the federal matching rate for emergency services drops from New Jersey’s current 90% expansion rate to approximately 50–65%. This does not eliminate emergency coverage, but it significantly increases the financial burden on the state.
- Cover All Kids remains intact because it is funded entirely by New Jersey for undocumented children. The OBBBA does not penalize states for using their own dollars to cover undocumented children.
These changes mean that thousands of New Jersey residents who are lawfully present in the United States—people who went through the legal process to obtain refugee, asylee, or humanitarian parole status—will lose access to federally funded health coverage starting October 2026, unless Congress acts.
What Democrats Want to Restore
In response, Democratic lawmakers in Congress have proposed measures to reverse several of these cuts. Their efforts aim to restore the federal Medicaid matching funds eliminated under the OBBBA, particularly for emergency medical services and for programs that assist lawfully present immigrants whose eligibility was stripped.
The Democratic proposals also seek to eliminate new work requirements, restore funding to rural hospitals, and extend enhanced ACA premium tax credits (topics not covered in this article). As the nonpartisan Kaiser Family Foundation has noted, these proposals do not create new eligibility for undocumented immigrants (who were already ineligible for federally funded coverage before the OBBBA). Rather, they aim to restore coverage for lawfully present immigrants like refugees and asylees, and to ensure that mixed-status families don’t lose access to care because of shifting political priorities or administrative red tape.
In addition, Democrats want to reinstate the higher federal cost-sharing for emergency services provided to immigrants without legal status—in practical terms, restoring the 90% reimbursement for states like New Jersey that maintain immigrant-inclusive safety nets.
Where Things Stand Now
New Jersey continues to be one of the more immigrant-friendly states when it comes to health coverage. Undocumented children remain protected under Cover All Kids. Lawfully present pregnant women receive full Medicaid with 12 months of postpartum coverage. Emergency care remains available to all through Emergency Medicaid, even as the federal government will cover a lower share of those costs beginning in October 2026.
However, the most significant near-term threat is to lawfully present immigrants—refugees, asylees, and humanitarian parolees—who will lose federal Medicaid eligibility entirely under the OBBBA unless that provision is reversed. Whether New Jersey chooses to bridge the gap with state dollars, as it has done for undocumented children, remains to be seen.
From a policy perspective, the direction of federal law will determine how sustainable New Jersey’s approach remains. If the state continues to shoulder the costs of inclusivity while federal funding shrinks, the long-term pressure on the state budget will grow. On the other hand, restoring the federal match for emergency and qualified immigrant coverage could stabilize the system and maintain access for some of New Jersey’s most vulnerable residents.
Final Thoughts
As a Medicaid lawyer practicing in New Jersey, I see firsthand how these laws affect real people. Families trying to navigate complex immigration and health systems often face confusion, fear, and financial strain. Understanding who qualifies—and how programs like Cover All Kids and Emergency Medicaid are funded—is essential for both residents and practitioners.
The bottom line is this: New Jersey has built a relatively compassionate model that balances legal restrictions with state-funded solutions. But that balance depends heavily on federal cooperation. With the OBBBA’s sweeping changes to lawfully present immigrant eligibility and the ongoing debate in Congress, the future of immigrant health coverage in New Jersey will likely hinge on how much support Washington is willing to restore.
by Jose D. Roman | Apr 10, 2025 | Consumer Advocacy, Legal Bulletin, Medicaid, Medicaid Planning, Medicaid Updates
The situation is all too common for Elder Law attorneys and their Medicaid applicant clients – a denial or termination of benefits due to supposedly insufficient documents, even when the agency is provided with everything it asked for. A recent decision, M.L. v. Essex County Division of Family Assistance and Benefits, A-0884-23 (March 18, 2025), highlights the typical scenario where the agency arbitrarily denies an application for reasons not apparent until after the fact. The court’s ruling underscores the importance of procedural fairness in Medicaid eligibility determinations and provides a summary of the law for advocates to use when pushing back on denials or terminations based on insufficient documents.
Case Background
M.L., an elderly nursing home resident, applied for Medicaid benefits on March 31, 2023. The Essex County Division of Family Assistance and Benefits initially requested additional documentation, including bank statements from Wells Fargo, to verify financial eligibility. M.L. promptly requested and obtained these records from his bank and provided copies to Essex County before the deadline. However, Essex County denied his application, claiming that he provided insufficient financial documentation and had unexplained withdrawals. M.L. promptly filed an appeal, as well as a second Medicaid application. The second application contained additional records, including records from a newly discovered Citizens Bank account. During the appeal, M.L. argued that he had substantially complied with Essex County’s requests. An administrative law judge (ALJ) agreed, ruling that M.L. had satisfied Medicaid eligibility requirements. However, the Division of Medical Assistance and Health Services (DMAHS) rejected the ALJ’s decision, affirming the original denial on the grounds that M.L. failed to provide all required documentation within the designated timeframe, including the additional statements from the Citizens Bank account.
Appellate Court’s Summary of the Law
Upon review, the Appellate Division found DMAHS’s final decision to be arbitrary, capricious, and unreasonable. The Court provided a useful review of New Jersey regulatory law that applies in these circumstances, which is summarized below.
The local County Welfare Agency (CWA) and its caseworkers “exercise direct responsibility in the application process to . . . receive applications.” N.J.A.C. 10:71-2.2(c)(2). The caseworker is charged with evaluating an applicant’s eligibility for Medicaid benefits. N.J.S.A. 30:4D-7a; N.J.A.C. 10:71-2.2(a); N.J.A.C. 10:71-3.15. “The process of establishing eligibility involves a review of the application for completeness, consistency, and reasonableness.” N.J.A.C. 10:71-2.9.
While the applicant is “the primary source of information,” the caseworker is responsible for making “the determination of eligibility and to use secondary sources when necessary, with the applicant’s knowledge and consent.” N.J.A.C. 10:71-1.6(a)(2). The caseworker is not limited in the use of secondary sources to obtain necessary verification information. N.J.A.C. 10:71-4.1(d)(3) states:
The CWA shall verify the equity value of resources through appropriate and credible sources . . . . If the applicant's resource statements are questionable, or there is reason to believe the identification of resources is incomplete, the CWA shall verify the applicant's resource statements through one or more third parties.
The applicant is responsible for cooperating fully with the verification process if the caseworker must contact a third party to verify an applicant’s resources. N.J.A.C. 10:71-4.1(d)(3)(i). The agency may perform a collateral investigation to “verify, supplement or clarify essential information.” N.J.A.C. 10:71-2.10(b).
Under N.J.A.C. 10:71-2.2, the caseworker must communicate with the applicant regarding the claimed deficiencies and then, under N.J.A.C. 10:71-2.10(b), provide an opportunity for the applicant to verify, supplement, or clarify the information before denying an application.
N.J.A.C. 10:71-2.2(e)(1) to (3) requires an applicant to:
- Complete, with assistance from the CWA if needed, any forms required by the CWA as a part of the application process;
- Assist the CWA in securing evidence that corroborates his or her statements; and
- Report promptly any change affecting his or her circumstances.
N.J.A.C. 10:71-2.2(c)(1) to (5) requires a caseworker to:
- Inform the applicants about the purpose and eligibility requirements for Medicaid Only,
- Inform them of their rights and responsibilities under its provisions and inform applicants of their right to a fair hearing;
- Receive applications;
- Assist . . . applicants in exploring their eligibility for assistance;
- Make known to . . . applicants the appropriate resources and services both within the agency and the community, and, if necessary, assist in their use; and
- Assure the prompt and accurate submission of eligibility data to the Medicaid status files for eligible persons and prompt notification to ineligible persons of the reasons for their ineligibility.
State agencies must “turn square corners” with the public they serve in carrying out their statutory responsibilities. W.V. Pangborne & Co. v. N.J. Dep't of Transp., 116 N.J. 543, 561–62 (1989). When this bedrock principle is read together with the above regulations, the dispositive legal conclusion is that both the applicant and the County have a duty under the regulations to take affirmative steps to communicate with each other regarding a pending application. The scope of this joint duty clearly includes the parties’ efforts to clarify prior communications about a pending application.
Court’s Ruling
Based on the summary of the law, the Appellate Division found that the applicant promptly gave the County what it asked for-- namely, the Wells Fargo statements. Upon receipt, the County’s duty was to review the pending application and notify the applicant concerning what, if any, additional information was required to make an eligibility determination. The record showed that the County failed to do so. Instead, it denied the March 31 application and only then informed the applicant that his application was deficient.
It followed that DMAHS’s final administrative decision adopting the improper denial of the March 31 application was arbitrary, capricious, and unreasonable. The Appellate Division reversed DMAHS’s decision and sent the case back to the County, instructing the agency to reopen and process M.L.’s Medicaid application.
Final Thoughts
Though practitioners know it is often the exception, this case serves as a crucial reminder that government agencies must adhere to procedural fairness when assessing Medicaid applications. Applicants have a right to clear communication and a reasonable opportunity to provide necessary documentation. Furthermore, state agencies cannot deny benefits based on minor technicalities or failures in their own procedures.
For Medicaid applicants facing similar challenges, this ruling reinforces the importance of persistence and legal advocacy. If you or a loved one has been wrongfully denied Medicaid benefits, consider consulting with an experienced attorney to ensure your rights are protected.
by Jose D. Roman | Jan 25, 2025 | Consumer Advocacy, Legal Bulletin, NJ Supreme Court
On January 9, 2025, the New Jersey Supreme Court issued a decision addressing whether the state’s old Tax Sale Law (before it was amended in 2024) violated the Fifth Amendment Takings Clause by allowing the forfeiture of surplus equity from tax foreclosures without just compensation. In an opinion by Chief Justice Stuart Rabner, in 257-261 20th Avenue Realty, LLC v. Alessandro Roberto (A-29-23) (088959) the Court found the prior version of the Tax Sale Law to be unconstitutional. Relying on the U.S. Supreme Court’s 2023 ruling in Tyler v. Hennepin County, the Court held that property owners in New Jersey have a recognized right to surplus equity—the value of a property beyond the amount owed in taxes. The ruling clarified that private lienholders, acting jointly with municipalities to enforce tax foreclosures, are considered state actors subject to the requirements of the Takings Clause of the US Constitution.
Background of the Case
The case arose from a Paterson, NJ property owner’s failure to pay three sewer tax bills totaling just $606.00. The City of Paterson placed tax liens on the property, which were purchased by 257-261 20th Avenue Realty, LLC at a public auction. Years later, the company filed for foreclosure, and the property owner failed to respond, resulting in a judgment of foreclosure.
The property owner subsequently sought to vacate the judgment, arguing that the property —valued at over $500,000.00 — held significant equity vital for his retirement. He had invested $200,000.00 in improvements and had set aside $50,000.00 to pay the judgment. Despite these circumstances, the foreclosure judgment transferred the entire property, including its substantial surplus equity, to the lienholder without compensating the property owner for the value exceeding the tax debt.
The trial court vacated the judgment under NJ Court Rule 4:50-1(f), finding exceptional circumstances, and the Appellate Division affirmed, citing the U.S. Supreme Court’s decision in Tyler v. Hennepin County (2023), which held that forfeiture of surplus equity in tax foreclosures violates the Takings Clause.
Key Issues Addressed by the NJ Supreme Court
- Takings Clause and Surplus Equity: The Takings Clause of the Fifth Amendment prohibits the government from taking private property for public use without just compensation. The NJ Supreme Court, relying on Tyler, held that surplus equity—the value of the property exceeding the tax debt—is a protected property right. The pre-2024 Tax Sale L allowed the complete forfeiture of surplus equity to lienholders, a practice deemed unconstitutional.
- Lienholders as State Actors: The Court rejected the argument that private lienholders are not state actors and thus not subject to the Takings Clause. Tax foreclosure involves a public function—collecting taxes—and relies on a statutory framework created by the state. The Court determined that the collaboration between municipalities and lienholders renders the latter state actors for constitutional purposes.
- Public vs. Private Use: The Court dismissed the contention that the taking of surplus equity was not for public use. The Tax Sale serves a public purpose by enabling municipalities to collect taxes. However, the US Constitution requires that property taken for public use must be accompanied by just compensation, which the pre-2024 TSL failed to provide.
Significance of the Tyler Precedent
The NJ Supreme Court’s decision heavily relied on the U.S. Supreme Court’s 2023 ruling in Tyler v. Hennepin County. In Tyler, the Court held that a Minnesota tax foreclosure law allowing the forfeiture of surplus equity was unconstitutional. Similarly, the NJ Supreme Court found that property owners in New Jersey have a recognized right to surplus equity under both state and federal law. As Tyler is binding precedent, the NJ Supreme Court clarified that it did not need to rely on Rule 4:50-1(f)to vacate the foreclosure judgment but instead resolved the case on constitutional grounds.
Impact on Tax Foreclosure in New Jersey
This ruling has profound implications for New Jersey’s tax foreclosure system. Property owners now have a constitutionally recognized right to retain surplus equity in foreclosure proceedings. Municipalities and lienholders cannot confiscate more value than is necessary to satisfy the tax debt. This is a clear shift toward greater accountability and fairness in tax foreclosure practices. It is a major win for the average New Jersey property owner.
by Jose D. Roman | Jan 16, 2025 | Consumer Advocacy
Homeopathy is a system of alternative medicine that uses extremely diluted over the counter substances to treat a wide variety of symptoms. It is based on an 18th century pseudoscientific claim that "like cures like," that is that the substances causing symptoms could, when diluted, treat sick individuals. While its proponents claim it offers a natural and effective means of healing, homeopathy lacks scientific credibility and is essentially used as a modern means of selling snake oil. Even though it is widely known that these treatments don't work, homeopathy remains legal and homeopathic products take up a massive amount of shelf space at retail drug stores, even in the State of New Jersey -- a state with some of the toughest consumer protection laws in the country. Why is this legal? Is there anything consumers can do to combat this in New Jersey?
What Is Homeopathy?
Homeopathy originated in the late 18th century with Samuel Hahnemann, a German physician who theorized that substances causing symptoms in healthy individuals could, when diluted, treat similar symptoms in sick individuals. Homeopathic remedies are typically diluted to the point where no molecules of the original substance remain, leading critics to fairly describe these products for what they actually are, sugar pills or placebos. Homeopathy is widely regarded as pseudoscience because it lacks empirical support. Key criticisms include:
- Scientific Implausibility: The principle of "like cures like" and the extreme dilutions used in homeopathy contradict basic principles of chemistry and biology. It also defies common sense. How can you dilute something out of existence and expect that the nothing you're left with will trigger a symptom fighting response in your body.
- Lack of Evidence: Systematic reviews have found no reliable evidence that homeopathy is more effective than a placebo.
- Safety Concerns: Homeopathic products are often marketed without rigorous testing for safety, consistency or contamination, unlike conventional pharmaceuticals.
Despite these issues, homeopathy persists, largely due to consumer demand and legal protections.
Why Is Homeopathy Legal in the United States?
Homeopathy is legal in the United States primarily because of historical and regulatory factors:
- The Food, Drug, and Cosmetic Act (1938): This law recognized homeopathic remedies as a category of drugs, giving them a unique status. The U.S. Food and Drug Administration (FDA) historically deferred to the Homeopathic Pharmacopeia of the United States (HPUS) for standards on homeopathic products.
- Limited Oversight: Until recently, the FDA did not rigorously regulate homeopathic products. While the agency has since updated its enforcement policies to prioritize products that pose risks to public health, many homeopathic remedies still reach consumers with minimal scrutiny.
- Consumer Protection vs. Freedom of Choice: Lawmakers have historically balanced consumer protection with individuals' rights to choose alternative treatments, even if they lack scientific support.
Legal Issues and Homeopathy in New Jersey
New Jersey does not have specific laws regulating homeopathy, but several legal issues can arise:
- Consumer Fraud Act: New Jersey’s Consumer Fraud Act (N.J.S.A. 56:8-1 et seq.) prohibits deceptive practices in the sale of goods and services. Misleading claims about the efficacy of homeopathic remedies could expose manufacturers and retailers to liability.
- Professional Licensing: Practitioners who incorporate homeopathy into their treatments must comply with state licensing laws. For example, licensed physicians and naturopaths offering homeopathic treatments must ensure that they do not misrepresent the efficacy of these remedies or engage in unprofessional conduct.
- Product Liability: If a homeopathic remedy causes harm due to contamination or improper labeling, manufacturers and distributors could face liability under New Jersey product liability laws.
- Insurance Coverage: Many insurance policies do not cover homeopathic treatments. Practitioners and patients may encounter legal disputes over reimbursement claims.
Conclusion
Homeopathy remains a legally accessible yet scientifically discredited practice in the United States, including New Jersey. While its legal status reflects historical and regulatory compromises, consumers should approach homeopathic remedies with skepticism and consult qualified healthcare professionals for evidence-based treatments.
For more information detailed information on the medical and scientific issues read Science-Based Medicine and NeuroLogica Blog.