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.

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.

Does the Mailbox Rule Apply to New Jersey Medicaid Applications?

Does the Mailbox Rule Apply to New Jersey Medicaid Applications?

by | Oct 7, 2025 | Legal Bulletin, Medicaid, Medicaid Planning, Medicaid Updates

When applying for Medicaid or completing annual renewal paperwork in New Jersey, deadlines are critical. Missing a due date for requested documents can lead to a denial of the application or termination of benefits—sometimes with devastating consequences. But what happens if you mail documents on time but the agency later claims they were received late or not at all? Can you rely on the legal principle called the Mailbox Rule to prove that you provided a timely response?

What Is the Mailbox Rule?

The Mailbox Rule is a common-law legal doctrine that creates a rebuttable presumption of receipt. If a letter is properly addressed, stamped, and mailed, the law presumes it was received by the addressee in the normal course of mail delivery. The New Jersey Supreme Court affirmed this rule in SSI Medical Services, Inc. v. State, 146 N.J. 614, 621 (1996), explaining:

Where the evidence shows that a letter properly directed was mailed and not returned, a presumption arises that it reached its destination in due course of mail and was actually received by the person to whom it was addressed.

Medicaid and the Limits of the Mailbox Rule: A.N. v. Passaic County (2024)

In a 2024 Medicaid Fair Hearing matter, A.N. v. Passaic County Board of Social Services, an applicant submitted a Medicaid application on January 31, 2024. The agency sent a written request for income verification, giving a deadline of March 2. The applicant later claimed he mailed the requested documents, but the county said they were never received—and no proof of mailing was provided.

In reviewing the case, the administrative law judge acknowledged the Mailbox Rule under SSI Medical Services and the traditional presumption that mailed documents are received. However, the judge concluded that there was no evidence that the requested documents were mailed or emailed. Because the applicant failed to provide reliable proof of mailing (e.g., a copy of postmarked mail, certified mail receipt, tracking number, fax confirmation, sent email), the agency’s determination stood, and the application was denied.

Key Takeaways

  • The mailbox rule is recognized in the Medicaid application context in New Jersey.
  • Applicants bear the burden of proving compliance with submission deadlines.
  • Testimony of mailing alone is likely not sufficient for court – you need to keep proof of mailing.

Best Practices for Medicaid Applicants

  1. Use certified or priority mail with a tracking number and return receipt.
  2. Retain copies of all submitted documents, including the envelope with the postmark.
  3. Follow up with the agency to confirm receipt—by phone, email, or in writing—and document all communications.
  4. Do not rely solely on regular mail, especially for time-sensitive or high-stakes Medicaid communications.

Conclusion

While the Mailbox Rule offers some protection in many legal contexts, it provides limited security in New Jersey Medicaid matters. Administrative agencies and courts expect actual, verifiable receipt of applications, verifications, and renewals. If you or your client is dealing with Medicaid, don’t take chances—take steps to ensure every document is received and acknowledged.

Fighting Back Against Arbitrary Medicaid Denials for Failure to Respond

Fighting Back Against Arbitrary Medicaid Denials for Failure to Respond

by | 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.

Medicaid is on the Chopping Block Again: Who Will Be Impacted in New Jersey?

Medicaid is on the Chopping Block Again: Who Will Be Impacted in New Jersey?

by | Mar 6, 2025 | Medicaid, Medicaid Planning

Since President Donald J. Trump’s re-election, discussions about the future of Medicaid have intensified. In January 2025, the Trump administration temporarily paused federal financial assistance—sparking widespread uncertainty about Medicaid funding. Although the order was later rescinded, concerns over potential funding disruptions remain.

In February 2025, House Republicans narrowly passed a budget resolution proposing $4.5 trillion in tax cuts paired with $2 trillion in spending reductions over the next decade. Notably, the budget includes $880 billion in cuts to Medicaid, a figure that has ignited debates, even within the GOP. And let’s be clear in case you hear anyone saying Medicaid is safe – the nonpartisan Congressional Budget Office has stated that Republicans cannot meet their $880 billion target without resorting to drastic cuts to Medicaid. To understand what’s at stake, let’s examine how Medicaid is structured in New Jersey.

What Is Medicaid?

Medicaid is a joint federal and state program that offers free or low-cost health coverage to eligible low-income individuals and families. It covers a broad range of services—from doctor visits and hospital stays to prescription drugs, preventive care, mental health services, and long-term care. Each state administers its own Medicaid program within federal guidelines, which means eligibility requirements and covered services can vary. Medicaid primarily serves very low-income adults, children, pregnant women, seniors, and individuals with disabilities, ensuring that vulnerable populations have access to essential healthcare. In New Jersey, Medicaid is divided into several programs, each targeting specific groups and each with their own eligibility criteria.

A. NJ FamilyCare Medicaid

NJ FamilyCare is a Medicaid program that provides free or low-cost coverage to eligible New Jersey residents under age 65. It includes Medicaid, the Medicaid expansion under the Affordable Care Act (New Jersey is one of the states that has opted in by accepting federal funding), and the Children's Health Insurance Program (CHIP). The expansion Medicaid component is widely expected to be targeted for cuts because it includes the often unfairly maligned Affordable Care Act Medicaid – the “Obamacare” expansion of Medicaid.

  • Who Does NJ FamilyCare Medicaid Cover?

Adults aged 19 to 64 can access NJ FamilyCare if their household income is at or below 138% of the Federal Poverty Level/FPL (133% plus a 5% income disregard). This is incredibly low and many adult minimum wage workers find themselves ineligible for Medicaid. For example this is a mere $21,597 per year for an individual and $44,367 for an adult living in a household of four. Pregnant people and children have more generous eligibility limits at 205% FPL for pregnant people and up to 355% FPL for children. These categories all fall under the umbrella of Modified Adjusted Gross Income (MAGI) Medicaid and only consider income, not assets when determining eligibility. Therefore, anyone of working age who abruptly loses their income can apply and receive health coverage without consideration of their assets such as retirement savings.

  • Who Will Be Impacted When NJ FamilyCare is Cut?

The answer is simple. Pregnant women, children and low wage-earning adults who don’t have access to or cannot reasonably afford high-cost employer sponsored coverage will take the brunt of the impact.  

B. SSI Medicaid and “Medicaid Only”

Individuals in New Jersey who qualify for Supplemental Security Income (SSI) benefits (a basic income support program) are automatically enrolled in Medicaid ensuring that they have access to health coverage. In addition, the “Medicaid Only” program extends coverage to individuals who have income and resources under the SSI limits but don’t actually receive SSI payments.

  • Who Does SSI Medicaid and Medicaid Only Cover?

SSI is a program that provides income support to seniors 65 and over, blind individuals, and disabled individuals who have zero or very low income. For 2025, eligible individuals with countable income below $967 per month and $2,000 or less in assets can qualify for SSI payments. For a couple the figures are $1,450 per month and $3,000 in assets. Essentially these are individuals with almost nothing in terms of basic income and assets who are living month to month.

  • Who Will Be Impacted When SSI Medicaid and Medicaid Only is Cut?

The answer is pretty straightforward, though depressing. Seniors and individuals who have been found to meet the federal government’s standards for blindness and permanent disability, who have zero or very little income. Essentially the poorest senior citizens and the poorest individuals with disabilities may find themselves without access to essential health coverage when SSI Medicaid and Medicaid Only is cut. 

C. Disabled Adult Child (DAC) Medicaid

Disabled Adult Child (DAC) Medicaid is specifically targeted toward individuals with disabilities, whose condition began before age 22. It allows them to retain Medicaid benefits even when their income suddenly exceeds SSI eligibility parameters.

  • Who Does DAC Medicaid Cover?

Essentially the program allows individuals with disabilities, whose condition began before age 22, to maintain Medicaid coverage even if they become ineligible for SSI or Medicaid Only due to receiving Social Security Disability Insurance (SSDI) benefits based on a parent’s earnings record. This situation typically arises when a parent retires, becomes disabled, or passes away, triggering SSDI benefits for the adult disabled child. While the increase in income from SSDI may disqualify the individual from SSI, federal law ensures the continuation of Medicaid benefits for those who were previously eligible under SSI but have lost it due to SSDI benefits. This safeguard is crucial, as Medicaid often covers services and supports not provided by Medicare or private insurance, ensuring that individuals with disabilities continue to receive necessary care without interruption.

  • Who Will Be Impacted When DAC Medicaid is Cut?

DAC Medicaid primarily benefits individuals with developmental and intellectual disabilities. However, since it impacts anyone whose condition began before the age of 22 it includes a wide variety of individuals struggling with physical, intellectual or mental disabilities. It’s sad but true – when this program is cut it will impact adult disabled individuals who have relied on Medicaid for most of their life.

D. Aged Blind Disabled (ABD) a/k/a Special Medicaid Program

In New Jersey, the Aged, Blind, and Disabled (ABD) Medicaid program, also known as Special Medicaid, provides supplemental healthcare coverage to seniors and individuals with disabilities who receive Medicare benefits. The program pays Medicare premiums, covers Medicare co-pays and deductibles, and offers services not covered by original Medicare Part A and B such as dental coverage. 

  • Who Does ABD/Special Medicaid Cover?

The program is open to low income individuals who are 65 years or older, blind or disabled and also receive Medicare. The income limits for ABD Medicaid are based on the Federal Poverty Level (FPL). As of 2025, the income limit is 100% of the FPL, which is $1,304 for an individual and $1,763 for a married couple. The program also has asset limits:  for individuals, the limit is $4,000, and it is $6,000 for couples. 

  • Who Will Be Impacted When ABD/Special Medicaid is Cut?

Retired seniors with low income who are living month to month on social security will be impacted significantly. Essentially this will punish retired individuals who worked in low wage jobs.  It will also impact low income blind and disabled individuals who receive Medicare. It is sad as these individuals living off of less than $2000 per month will now need to figure out how to pay additional healthcare expenses, including Medicare premiums, co-pays and deductibles, and essential non-covered services such as dental and home health aides. Many will forego essential medical care altogether due to the cost.

E. NJ Workability

NJ WorkAbility is a program that enables employed individuals with disabilities to obtain comprehensive Medicaid coverage. The program has generous limits compared to other Medicaid programs. Essentially it was designed to encourage individuals with disabilities to work without fear of losing their health insurance.

  • Who Does NJ WorkAbility Medicaid Cover?

Eligibility for NJ WorkAbility Medicaid was recently expanded and is now relatively simple. You must be a New Jersey resident, have a disability determination by the Social Security Administration or the State, and have proof of employment. The program does not specify a minimum number of work hours or earnings to qualify, so even individuals with small part-time or irregular jobs can qualify as long as there is proof of employment. The program does not have an asset limit and does not count a spouse’s income. People with countable income above 250% FPL may have to pay a premium on a rising scale.

  • Who Will Be Impacted When NJ WorkAbility Medicaid is Cut?

Working individuals with disabilities will lose insurance or have increased insurance and healthcare costs when NJ WorkAbility is cut. This is unfortunate, especially when the people advocating for Medicaid cuts often claim that Medicaid recipients choose not to work so they can keep public benefits. 

F. Managed Long Term Services and Supports (MLTSS) Medicaid

Managed Long Term Services and Supports (MLTSS) is a New Jersey Medicaid program designed to provide comprehensive long-term care services to individuals who require assistance due to age, disability, or chronic illness. MLTSS covers services beyond those offered by standard Medicaid, including nursing home care, home and vehicle modifications, home-delivered meals, and assisted living services.

  • Who Does MLTSS Medicaid Cover?

Because Medicare does not cover long term care such as nursing home care, qualifying for Medicaid is typically the only way most people can pay for these services. However, this program is extremely complicated, and many individuals hire a lawyer when applying for the program. The application process includes a “five-year lookback,” which is a detailed examination of the income and assets of the applicant and their spouse in the prior 60-month period. To be eligible, an individual applicant’s monthly income must not exceed $2,901 (2025) and countable assets are limited to $2,000. The application process includes looking at a married couples combined assets even if they are not jointly owned. The application often will need to spend down assets in order to meet the $2000 limit. The non-applicant spouse may also need to spend down assets because the amount he or she can retain is limited to between $31,584 and $157,920. These guidelines are meant to ensure that poor and middle-class individuals have access to essential long-term care services while maintaining some financial stability.

  • Who Will Be Impacted When MLTSS Medicaid is Cut?

With nursing care often costing in excess of $10,000 per month MLTSS Medicaid and similar programs throughout the county has become the backbone of our long term care system. Any cuts to this program will cause significant disruption to people in need of nursing home, assisted living or similar services at home.

Final Thoughts

The proposed Medicaid cuts could have far-reaching consequences for some of our most vulnerable citizens. In New Jersey, each Medicaid program serves a critical role—from providing essential coverage to low-income adults, pregnant individuals, and children to supporting seniors and those with disabilities. Drastic reductions in Medicaid funding would not only undermine healthcare access but also exacerbate financial insecurity for many families.