Medicaid Unwinding in New Jersey: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in New Jersey are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This will lead to a loss of coverage through a process called unwinding.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
New Jersey Medicaid has started reviewing who is currently eligible for Medicaid. If you’re enrolled in the state’s program, make sure NJ FamilyCare has your correct contact information. If the agency can’t reach you or if you’re no longer eligible for Medicaid, you could lose coverage as early as June 1, 2023.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times between January 2020 and February 2023.
People who were eligible for Medicaid at the start of the COVID PHE were able to keep their coverage during the pandemic without having their eligibility reviewed. This is because all states — including New Jersey — and territories were mandated to provide continuous coverage during the PHE.
But the PHE expired on May 11, 2023. And that marked the end of most COVID provisions, like automatic Medicaid renewals, which stopped nationwide in March. These changes could cause 5 million to 14 million Medicaid enrollees across the country to lose coverage.
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Here’s what you need to know about Medicaid changes in New Jersey and what to do if you lose your insurance coverage.
Why is Medicaid changing nationwide?
Now that the PHE has ended, COVID-19 will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals are no longer automatic. This is being referred to as the unwinding of Medicaid.
The unwinding process will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
What’s happening with Medicaid renewal in New Jersey?
The Division of Medical Assistance and Health Services (DMAHS) is responsible for overseeing New Jersey’s Medicaid program, which is called NJ FamilyCare. The DMAHS has a redetermination plan and unwinding guidance document that outline how the state intends to conduct eligibility reviews for more than 2.2 million enrollees.
Now that New Jersey has begun the redetermination process, residents who no longer qualify for Medicaid or the Children’s Health Insurance Program (CHIP) could be disenrolled as early as June 1, 2023. Officials at the New Jersey Department of Human Services estimate that about 293,000 people in the state could ultimately lose coverage.
Through the outreach campaign Stay Covered NJ, state officials are urging Medicaid enrollees to confirm or update their contact information with NJ FamilyCare. Enrollees can find resources to help with this process in English, Spanish, and American Sign Language. And NJ FamilyCare also offers assistance in many other languages.
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In general, residents can confirm or update their contact information by calling the NJ FamilyCare information line at 1-800-701-0710.
What to expect during the renewal process
New Jersey began reviewing Medicaid enrollees’ eligibility in April 2023 and will complete this process in May 2024. NJ FamilyCare will automatically renew your coverage if representatives can confirm your eligibility without sending a renewal packet. If your coverage is being automatically renewed, you will receive a notice in the mail letting you know.
If NJ FamilyCare needs information in order to review your eligibility, you will get a renewal packet about 2 months before your renewal date. You will have 30 days to return your packet via mail or fax — or in some cases, email. Your renewal packet should specify your return options.
If you fail to return your completed renewal packet by the deadline, you will have 90 days after your coverage ends to submit your information for consideration without having to reapply. If you send in your information within those 90 days and are renewed, you won’t have a coverage gap.
What should I do if I lose my Medicaid coverage in New Jersey?
In order to receive Medicaid in New Jersey, you must meet all of the following criteria:
You must be a New Jersey resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You must need assistance with access to healthcare or insurance coverage.
Your annual household income before taxes are withheld must be below the limit for your household size.
In New Jersey, you may also qualify for reasons in addition to income, including if you are:
Pregnant
A child who is 18 or younger, regardless of immigration status
An immigrant who is 19 or 20, lawfully residing in the U.S., and from a low-income household
Responsible for the care of a child who is 18 or younger
Blind
65 or older (and meet certain criteria)
A person with a disability or a household member of someone who has a qualifying disability
A former foster child who is 25 or younger
In need of nursing home care
A person with family planning needs
In need of treatment for breast or cervical cancer (and have been screened or are still undergoing treatment)
If you no longer meet the requirements or NJ FamilyCare can’t reach you, you will lose your benefits, which could leave you temporarily uninsured. If you lose Medicaid benefits, NJ FamilyCare will check if you qualify for other state health insurance programs. If you don’t, you will be referred to GetCoveredNJ, the state’s Affordable Care Act (ACA) insurance marketplace.
If you lose your coverage but believe you still qualify, you can reapply for Medicaid. To reapply, you should call your local County Board of Social Services or NJ FamilyCare at 1-800-701-0710.
If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for other low-cost or free healthcare options. You can also use GoodRx coupons to save on your prescription medications. In addition, you may be able to enroll in an alternative health insurance option, such as:
Affordable Care Act (ACA) marketplace plan: You may be able to enroll in an ACA health plan through GetCoveredNJ, which is the state’s ACA marketplace. You could find a plan for $10 or less per month if you qualify for a premium subsidy. If you lose Medicaid, you can purchase a plan through GetCoveredNJ during an unwinding special enrollment period from March 31, 2023 to July 31, 2024.
Employer plan: If you have a job, you may be able to get employer-sponsored health insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA): If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
New Jersey Medicaid resources
Here are some resources where you can learn more about Medicaid in New Jersey and upcoming changes related to the end of the PHE:
New Jersey Medicaid office: The DMAHS oversees and administers the state’s Medicaid program, NJ FamilyCare.
New Jersey Medicaid redetermination: Read more about New Jersey’s redetermination plan and unwinding guidance.
New Jersey Medicaid office phone assistance: You can call NJ FamilyCare at 1-800-701-0710.
New Jersey Medicaid FAQs: Find the answers to frequently asked questions.
The bottom line
Automatic Medicaid renewals stopped nationwide on March 31, 2023 in advance of the COVID-19 public health emergency (PHE) ending on May 11, 2023.
New Jersey started reviewing Medicaid eligibility for NJ FamilyCare enrollees in April 2023 and will continue through May 2024. The state will be able to confirm eligibility for some people automatically. If your case can’t be processed this way, you’ll be sent a renewal packet in the mail. So it’s important to confirm or update your contact information by calling the NJ FamilyCare information line at 1-800-701-0710.
If you lose your Medicaid coverage, you may still qualify for health insurance through another provider. Your options may include Get Covered NJ marketplace plans, Medicare, or job-based insurance.
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References
Administration for Strategic Preparedness & Response. (2020). Determination that a public health emergency exists.
Administration for Strategic Preparedness & Response. (2023). Renewal of determination that a public health emergency exists.
Centers for Medicare & Medicaid Services. (2023). Temporary special enrollment period (SEP) for consumers losing Medicaid or the Children’s Health Insurance Program (CHIP) coverage due to unwinding of the Medicaid continuous enrollment condition – Frequently asked questions (FAQ).
Livio, S. K. (2023). Nearly 300K in N.J. could lose Medicaid coverage as pandemic emergency ends. NJ.com.
Medicaid.gov. (n.d.). Renew your Medicaid or CHIP coverage.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
NJ FamilyCare. (n.d.). Who is eligible?
State of New Jersey Department of Human Services. (n.d.). State report on plans for prioritizing and distributing renewals following the end of the Medicaid continuous enrollment provisions.
State of New Jersey Department of Human Services. (n.d.). Stay CoveredNJ - FAQs.
State of New Jersey Department of Human Services. (2023). Medicaid communication no. 23-03.
TheNJDHS. (2023). ACTUALIZACIÓN DE #NJFAMILYCARE. [Video]. YouTube.
TheNJDHS. (2023). IMPORTANT NJ FAMILYCARE UPDATE! [Video]. YouTube.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
