NJ Medicaid 2026 Community Spouse Maintenance Adjustments

by | Jul 21, 2026 | Legal Bulletin, Medicaid, Medicaid Updates

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services issued Medicaid Communication No. 26-05 on June 11, 2026. The communication announces annual adjustments to the Community Spouse Maintenance Allowance (CSRA), shelter threshold, and related figures under N.J.A.C. 10:71-5.7, effective July 1, 2026. These figures govern how much of an institutionalized spouse's income may be set aside to support the spouse remaining in the community.

Key updated figures effective July 1, 2026:

  • Community spouse base maintenance allowance: Increased from $2,643.75 to $2,705.00 per month.

  • Excess shelter cost threshold: Increased from $793.13 to $811.50 per month. Shelter costs above this amount are added to the base allowance.

  • Standard utility allowance: Remains $878.00 per month (effective October 1, 2025), applicable where the community spouse directly pays utility charges.

  • Community spouse resource allowance: Unchanged. The greater of $32,532 or one-half of the couple's countable resources, not to exceed $162,660.

  • Home equity maximum: Unchanged at $1,130,000.

The Community Spouse Maintenance Allowance is calculated by starting with the $2,705.00 base, adding any shelter costs exceeding $811.50 (including the $878.00 utility allowance if directly paid), and then subtracting the community spouse's own gross income. The result is the amount that may be deducted from the institutionalized spouse's income before applying it to the cost of care.

The full communication, including a fact sheet with computation examples, is available here.

Medicaid Eligibility for Lawfully Present Immigrants in New Jersey: What the New Federal Law Means for NJ FamilyCare

Medicaid Eligibility for Lawfully Present Immigrants in New Jersey: What the New Federal Law Means for NJ FamilyCare

by | Jun 9, 2026 | Consumer Advocacy, Legal Bulletin, Medicaid, Medicaid Updates

Federal law is changing who qualifies for NJ FamilyCare. Beginning October 1, 2026, many lawfully present immigrants may lose their coverage. Congress passed the One Big Beautiful Bill Act, which President Trump signed into law in 2025. Among its many provisions is a significant restriction on Medicaid eligibility for non-citizen immigrants. Starting October 1, 2026, certain lawfully present immigrants who are currently enrolled in NJ FamilyCare — New Jersey's name for its Medicaid program — may no longer qualify.

This is not a future concern. NJ has already begun mailing letters to potentially affected members to gather information and assess eligibility before the October 1 deadline. If you or someone you know receives one of these letters, the worst thing to do is ignore it.

Who Is Affected

The changes target a specific set of immigration categories. The following groups of lawfully present non-citizens may lose NJ FamilyCare coverage on October 1, 2026:

  • Refugees;

  • Asylees;

  • Certified victims of trafficking and their spouse, child, sibling, or parents;

  • Veterans or active-duty military and spouses or unmarried dependents who also have qualified non-citizen status;

  • Iraqi and Afghani parolees;

  • Individuals who were paroled into the U.S. between February 24, 2022 and September 30, 2024 under the Ukrainian Humanitarian Parole (UHP) program; and

  • People whose deportation is being withheld.

What these categories share is that they represent people who entered the United States through humanitarian or protection-based pathways — people who, in many cases, fled violence or persecution. Under existing rules, federal law treated many of them as eligible for Medicaid. The new law removes that eligibility for those who have not taken a specific additional step: transitioning to Lawful Permanent Resident (LPR) status.

The Green Card Exception

Adjusting to LPR status — becoming a permanent resident with a green card — does not automatically solve the problem. The law imposes a five-year waiting period. If you transitioned to LPR status less than five years ago, you may still be ineligible. The five-year clock runs from the date the immigrant obtains qualified alien status.

There are, however, carve-outs to the five-year rule. If you originally arrived in one of the affected categories and you have since transitioned to LPR status, you may still qualify even if it has been less than five years. These categories include:

  • Refugees;

  • Asylees;

  • Certified victims of trafficking and their spouse, child, sibling, or parents;

  • Veterans or active-duty military and spouses or unmarried dependents who also have qualified non-citizen status;

  • Amerasian immigrants;

  • Iraqi and Afghani special immigrants and parolees;

  • Individuals who were paroled into the U.S. between February 24, 2022 and September 30, 2024 under the Ukrainian Humanitarian Parole (UHP) program; and

  • People whose deportation is being withheld.

The state has been directed to treat those individuals more favorably than others in the LPR-under-five-years category.

If that sounds complicated, it is. The intersection of immigration status and Medicaid eligibility has never been simple, and the new law adds another layer of complexity. If you are uncertain whether these changes apply to you, do not try to figure it out alone.

Who Is Not Affected

Not every non-citizen is at risk. In addition to the categories noted above, several groups will continue to qualify under the new rules including:

  • Lawful Permanent Residents of at least 5 years (calculated from date on green card);

  • Lawfully present non-citizens who are pregnant, or under the age of 21;

  • Cuban/Haitian Entrants;

  • Compact of Free Association (COFA) migrants, including individuals from Micronesia, Marshall Islands, and Palau; and

  • Children under 19, regardless of their immigration status.

These populations are protected by separate statutory provisions and should not see a change in their eligibility on October 1.

What New Jersey Is Already Doing

NJ FamilyCare is not waiting until October. The state has begun sending outreach letters to members whose immigration status may bring them within the affected categories. These letters are not yet termination notices — they are requests for information to help the state determine who remains eligible and who does not.

If NJ FamilyCare already has what it needs to confirm your continued eligibility, you will receive a letter telling you your coverage has been renewed. If it needs more, you will receive a request for documentation or a renewal packet. The critical thing is to respond promptly. Failing to respond can result in a gap or termination of coverage, even if you are actually still eligible.

Members should also make sure their contact information is current. If your address or phone number has changed, call NJ FamilyCare Customer Service at 1-800-701-0710 (TTY: 711) now, before any letter goes undelivered.

The Broader Picture

These changes do not exist in isolation. The same legislation that is cutting Medicaid eligibility for immigrants also introduces work and community engagement requirements for certain adult enrollees beginning January 1, 2027, and shortens the renewal period from annually to every six months for those in certain plans. The cumulative effect of these changes is a significant increase in administrative burden on the states and more paperwork for some of the most vulnerable Medicaid enrollees in the state.

New Jersey has historically taken steps to extend coverage to immigrant populations beyond what federal law requires but those programs cost money. Whether New Jersey will maintain state funded coverage options is an open question.

Learn More

For a detailed explanation of how immigration status affects NJ Medicaid eligibility under existing rules, see our guide: NJ Medicaid and Immigration Status — What You Need to Know.

For a broader overview of the federal Medicaid cuts in the One Big Beautiful Bill Act affecting New Jersey residents, see: Federal Medicaid Cuts: What New Jersey Residents Need to Know.

The official NJ DMAHS information page on these changes is available at nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml. The state has indicated it will update that page as additional guidance becomes available.

Increase in the Medicaid Penalty Divisor Effective April 1, 2026

by | Apr 7, 2026 | Legal Bulletin, Medicaid, Medicaid Planning, Medicaid Updates

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services issued Medicaid Communication No. 26-04 on April 6, 2026. The communication announces an increase in the Medicaid penalty divisor, effective April 1, 2026. The penalty divisor has increased from $402.74 to $420.67 per day.

The penalty divisor is the average daily cost of nursing home services in New Jersey, determined through an annual independent survey of all nursing facilities in the state. It is used to calculate the length of a Medicaid penalty period — the period of ineligibility imposed when an individual applying for Long Term Services and Supports (LTSS) has transferred assets for less than fair market value. The number of penalty days is calculated by dividing the value of the transferred asset by the daily penalty divisor, rounded down, with the penalty clock starting on the date the individual is otherwise determined eligible.

For a detailed discussion on transfer penalties read The 5-Year Lookback Rule in New Jersey: What It Is, How It Works, and Why Timing Matters.

Practitioners handling Medicaid planning matters involving asset transfers should update their calculations immediately. Read the full communication here.

When Liens Collide: DDD Can Collect Now, Medicaid Must Wait

When Liens Collide: DDD Can Collect Now, Medicaid Must Wait

by | Mar 31, 2026 | Estate Administration, Estate Planning, Guardianship, Intestate Estate (No Will), Last Will and Testament, Legal Bulletin, Medicaid, Medicaid Estate Recovery, Medicaid Planning, Medicaid Updates, Trusts

A decision from the New Jersey Appellate Division published June 17, 2025 (In the Matter of G.W.) has clarified a critical and previously unsettled area of law concerning public benefit liens. The court held that a lien issued by the Division of Developmental Disabilities (DDD) is immediately enforceable, while a Medicaid lien cannot be collected until the beneficiary’s death — a distinction with significant consequences for estate planning.

The Background

Gabrielle W., an adjudicated incapacitated adult, received residential services funded by both DDD and Medicaid. When she inherited $600,000 from her sister’s estate, Arc of Bergen and Passaic Counties, her court-appointed property guardian, sought to protect her Medicaid eligibility by transferring those funds to a special needs trust. But standing in the way was a $1,052,304 lien from DDD for the cost of her care — a lien DDD sought to enforce immediately.

The trial court declined to enforce the DDD lien, ruling instead that Medicaid’s future estate recovery rights had priority. The court reasoned it was in Gabrielle’s best interest to preserve her Medicaid eligibility and protect the trust. But on appeal, the Appellate Division disagreed.

The Court's Holding

The Appellate Division reversed the lower court’s order, emphasizing that DDD liens are enforceable immediately under N.J.S.A. 30:4-80.1. These liens attach to the property of a living person who receives services from DDD. On the other hand, Medicaid liens can only be asserted posthumously, pursuant to N.J.S.A. 30:4D-7.2, and only against the estate of the deceased Medicaid recipient.

The court concluded there is no statutory conflict: both liens can coexist, but they operate on distinct timelines. In the case of a living person like Gabrielle, DDD had the only legally viable lien. Medicaid’s recovery rights would not ripen until Gabrielle’s death.

Why This Matters

This case is a clear warning to guardians, trustees, and estate planners: Inherited assets cannot be shielded from DDD repayment obligations simply by invoking Medicaid's future claim rights. If a client receives services from DDD and comes into money, the DDD lien must be addressed promptly — either by repayment or through the statutory compromise process. The court also made clear that a “best interests” argument cannot override a legislatively mandated lien. Courts must enforce the statutes as written.

Planning Tip

If you have a loved one who receives public benefits like Medicaid or services from DDD, careful estate planning is essential. Leaving them an inheritance outright — even with good intentions — can jeopardize their benefits and trigger immediate repayment obligations. Instead, consider using special needs trusts or other protective planning tools to ensure their continued eligibility and long-term care without exposing them to liens or disruptions in services.

The G.W. case illustrates precisely what happens when protective planning is absent. Gabrielle's sister died intestate — without a will — which meant the $600,000 passed to Gabrielle outright under New Jersey's laws of intestate succession. There was no will directing those funds into a Special Needs Trust, no advance coordination with an elder law attorney, and no mechanism to receive the inheritance in a protected form. The result was an immediate lien enforcement proceeding that consumed the entirety of the inheritance and left nothing for Gabrielle's ongoing care needs.

Had Gabrielle's sister executed a will with proper special needs planning, she could have directed her estate — or the portion intended for Gabrielle — into a third-party Special Needs Trust. Unlike a first-party trust funded with the beneficiary's own assets, a third-party SNT is established with someone else's money and carries no Medicaid payback requirement at death. Gabrielle would have received the benefit of those funds without triggering the DDD lien, and without disrupting her Medicaid eligibility.

This is one of the most important and underappreciated points in elder law and disability planning: the person doing the planning is often not the disabled individual, but the family member who intends to leave them something. A parent, sibling, or other relative who has a loved one receiving public benefits should have a will — and that will should account for the beneficiary's disability. Leaving assets outright to a Medicaid or DDD recipient, however well-intentioned, can do more harm than good.

Medicaid and Immigration in New Jersey: What a Medicaid Lawyer Wants You to Know

Medicaid and Immigration in New Jersey: What a Medicaid Lawyer Wants You to Know

by | 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.

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.