New Jersey Medicaid Guide: NJ FamilyCare, MLTSS & Eligibility (2026)

New Jersey Medicaid delivers nearly all of its long-term care through managed care, so in 2026 a single applicant who needs a nursing-facility level of care qualifies with income up to $2,982 per month and no more than $2,000 in countable assets, then enrolls in a plan that pays for care at home, in assisted living, or in a nursing facility.

New Jersey Medicaid runs under the brand NJ FamilyCare and is administered by the Division of Medical Assistance and Health Services (DMAHS) inside the Department of Human Services. It routes long-term services and supports through MLTSS (Managed Long Term Services and Supports) rather than a standalone nursing-home program.1

In practical terms, you don't apply to a separate nursing-home Medicaid program: you qualify for Medicaid, enroll in a managed care plan, and that plan coordinates and pays for your care whether you live at home, in assisted living, or in a nursing facility. This guide focuses on coverage for seniors and people with disabilities: who qualifies, the 2026 income and asset limits, what MLTSS pays for, how to apply, and where to get free local help.2

The 60-Second Version

NJ FamilyCare is the umbrella brand for New Jersey Medicaid. It covers two broad groups under different rules. Children, parents, pregnant residents, and the adults added by the Affordable Care Act expansion qualify on income alone, measured as Modified Adjusted Gross Income (MAGI). Seniors 65 and older and people who are blind or disabled qualify under separate, SSI-related rules that count both income and assets, and those are the rules that govern long-term care.1

If the need is long-term care, MLTSS is the door. Eligibility runs on two separate tracks that both have to clear: a clinical determination that you need a nursing-facility level of care, and a financial determination against the 2026 limits below. For adults 21 and older, how the clinical screening gets scheduled depends on where you live and whether you already have Medicaid (all three routes are in the application section below); the county social service agency, which New Jersey's aged, blind, and disabled materials also call the county welfare agency, handles the financial application.2

How New Jersey Delivers Long-Term Care: MLTSS

This is the part that surprises families. New Jersey does not run a standalone "nursing-home Medicaid" program you apply to directly. Since 2014, when the state moved long-term care into managed care under a federal Section 1115 demonstration waiver, almost all Medicaid long-term services and supports flow through MLTSS.2

In practice that means you enroll in one of the state's contracted NJ FamilyCare managed care organizations, and that plan coordinates all of your services and provides comprehensive supports across every setting: your own home, an assisted living facility, community residential services, or a nursing home. As of 2026 the contracted plans are Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup New Jersey). The state describes MLTSS as designed to expand home and community-based services, promote community inclusion, and ensure quality and efficiency.4

New Jersey nursing-home prices run well above the national median: the CareScout 2025 Cost of Care Survey puts the statewide median for a semi-private room at $153,300 a year, 13th highest among the states against a national median of $114,975, and a private room at $173,375, 12th highest against $129,575 nationally. That gap is why Medicaid coverage matters so much once a family faces a nursing-facility stay.5

Who NJ FamilyCare Covers

NJ FamilyCare is broad. It covers:

• Children and teens in low-income families, plus CHIP-funded children at somewhat higher incomes.
• Parents and other caretaker relatives.
• Pregnant residents.
• Adults ages 19 to 64 added by the ACA expansion (the income-based group), who qualify with income up to 138% of the federal poverty level, or $1,836/month for a single person in 2026.6
• Seniors 65 and older, and people who are blind or disabled, under Supplemental Security Income-related rules.6
• People who need long-term care through MLTSS.

The first four groups qualify on income (MAGI). The last two are the ones this guide focuses on, because they're governed by the income-and-asset rules that decide whether Medicaid will pay for a nursing home or in-home care.

New Jersey Medicaid Eligibility Pathways: MAGI vs. ABD

There are two financial frameworks, and which one applies depends on why you qualify.

MAGI (income-only). Children, families, pregnant residents, and ACA-expansion adults are measured on Modified Adjusted Gross Income against a percentage of the federal poverty level. There's no asset test for these groups. Most people apply online and are enrolled in a managed care plan for regular health coverage.6

ABD and long-term care (income and assets). Aged, blind, and disabled applicants who are not seeking long-term care qualify through the New Jersey Care Special Medicaid Programs, which count assets as well as income and use an income limit of 100% of the federal poverty level, or $1,330/month for a single person in 2026, with a resource limit of $4,000. For long-term care specifically, New Jersey uses a higher special income standard of $2,982/month but a strict $2,000 asset limit, and it applies the federal spousal-impoverishment protections that let a married applicant's spouse keep a share of the couple's income and assets. Those 2026 figures are below.6

New Jersey Medicaid 2026 Long-Term-Care Financial Eligibility

The figures below apply to MLTSS and institutional (nursing-facility) Medicaid for 2026. The income limit is set at 300% of the federal SSI benefit rate, and the spousal-impoverishment numbers are the federal 2026 standards New Jersey applies. For the full breakdown across every pathway, including the MAGI and aged/blind/disabled limits, see our guide to New Jersey Medicaid eligibility and income limits.3

An applicant whose income runs above $2,982 a month isn't automatically disqualified. New Jersey lets you set up a Qualified Income Trust, sometimes called a Miller trust, that holds the excess income and directs it toward the cost of care so you can still meet the limit. Note what is not on the list above: New Jersey's own MLTSS and aged, blind, and disabled publications set no couple income limit for MLTSS or institutional Medicaid. Where one spouse applies and the other does not, the state's MLTSS guidance says only that some of the couple's marital assets are set aside for the non-applying spouse under the spousal-impoverishment rules. The 60-month look-back means transfers or gifts you made in the five years before applying are reviewed and can trigger a penalty period.3

The primary home stays exempt while a spouse or dependent lives there, within the federal long-term-care home-equity limit. For 2026 that limit is $752,000 unless the state elects a higher amount, up to $1,130,000; confirm the standard your caseworker is using before you count on a number.7

What MLTSS Covers

MLTSS is the long-term care side of NJ FamilyCare, and it provides comprehensive services and supports whether you live at home, in an assisted living facility, in community residential services, or in a nursing home. Care management is one of the services it includes: as a member you have access to a care manager who helps you coordinate your medical care, long-term services and supports, behavioral health, and regular NJ FamilyCare state plan services such as medical day care and personal care assistance, through an individualized plan of care. The precise service package is set by the state's MLTSS contract and administered by your plan, so ask your care manager which services your plan of care can include. NJ FamilyCare also offers a self-directed option, the Personal Preference Program, through which a member can select the home care services that best suit their needs and hire their own workers, covered in the paid-caregiving section below.4

Where you live changes how your income is treated. A member in a nursing facility keeps a $50 monthly Personal Needs Allowance and applies the rest of their income toward the cost of care. That cost share is calculated by the county welfare agency on the Personal Responsibility form, and the long-term care facility bills and collects it. The cost-share rules New Jersey publishes are written for members living in a facility, so if you receive MLTSS at home, ask your care manager how your income will be treated rather than assuming the facility rules carry over.8

How to Apply for NJ FamilyCare

The route depends on what you're applying for. For the full step-by-step, see our guide to how to apply for New Jersey Medicaid.1

Clinical eligibility for an adult means you need hands-on help with three or more activities of daily living, such as bathing, dressing, toileting, transfers, or eating, or you have cognitive deficits that require supervision and cueing with three or more of those activities.2

Estate Recovery in New Jersey

Like every state, New Jersey is required by federal law to seek repayment from the estates of people who received Medicaid long-term care at age 55 or older, and from anyone who was permanently institutionalized.7 New Jersey reaches past that federal floor in what it counts: DMAHS recovers all Medicaid payments made for services received on or after age 55, not only long-term-care services, including the capitation payments made to a managed care plan on the member's behalf. Recovery happens after death, and it is deferred while a surviving spouse, a surviving child under 21, or a surviving child of any age who is blind or permanently and totally disabled is living. An undue-hardship waiver can be requested.9

New Jersey goes further than probate: it is an expanded-estate recovery state. For recipients who died on or after April 1, 1995, state law (N.J.S.A. 30:4D-7.2 and N.J.A.C. 10:49-14.1) defines the recoverable estate to include not only probate assets but also property that passes outside probate (through joint tenancy, a life estate, a living trust, or survivorship), so putting a home in joint names does not automatically place it beyond DMAHS's reach. Because the rules and exemptions get detailed, families planning around a home should talk with an elder-law attorney before transferring property. For the full rules, deferrals, and how to protect a home, see our guide to New Jersey Medicaid estate recovery.10

Paid Family Caregiving in New Jersey

Many families want to know whether Medicaid will pay a relative to provide care. In New Jersey it can, through the participant-directed option within MLTSS and the state's Personal Preference Program, which let an eligible member hire and direct their own workers, including family members. N.J.A.C. 10:60-3.8(b) expressly excepts the personal preference program from the rule that otherwise bars paying a family member under NJ FamilyCare Plans B and C, which is more than many states allow. That same subsection grants no exceptions for legally responsible relatives, meaning a spouse or legal guardian of an adult, or a parent or legal guardian of a minor child, so confirm a spouse with the health plan rather than assume it. The exact options depend on your plan and your care plan.11

For the details on getting paid, the programs involved, and the steps, see our guide on how to get paid to care for a family member in New Jersey and the broader New Jersey caregiver programs guide.

PACE: An Alternative for the Frail Elderly

For some older adults who qualify for nursing-facility-level care but want to stay in the community, the Program of All-Inclusive Care for the Elderly (PACE) is an alternative to MLTSS. PACE wraps all medical and long-term care, including a day center, primary care, therapies, and transportation, into one program for people 55 and older who meet a nursing-facility level of care and can be served safely in the community. Enrollment requires living in a PACE organization's service area.12 PACE became available in all 21 New Jersey counties in January 2026, so a program should now be reachable from anywhere in the state.11

If NJ FamilyCare Denies or Cuts Your Coverage

A denial is not the end of the road, and the deadline to challenge it is usually shorter than people expect.

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.13 For an eligibility decision, your deadline is the date printed on your own notice of action. The 90 days you may have seen quoted is 42 CFR 431.221(d)'s ceiling on what a state may allow, never a window you are guaranteed, and a shorter state deadline binds you completely.14 This guide states no New Jersey figure for eligibility appeals because it has no New Jersey source it can quote for one, and a number nobody can source is worse than no number. Read the date off your notice, and if it is missing or unclear, call your County Welfare Agency (County Board of Social Services) and ask before the date passes.

A managed care service denial runs on a different clock, in two steps. When your NJ FamilyCare plan denies a service, you have 60 calendar days from the denial letter to file the plan's internal appeal, then 120 calendar days from the internal-appeal denial letter to request a Medicaid fair hearing.15

A third and earlier deadline matters most if the service is already running. To keep an already-authorized service in place during the appeal, request continuation within 10 calendar days of the date on the plan's denial letter, or by the end of the prior approved authorization, whichever is later.15 Federal law ties the same protection to requesting the hearing before the date the action takes effect.16 Miss that earlier date and you may still appeal, but coverage can stop in the meantime.

See New Jersey Medicaid Appeals and Fair Hearings for how to file and what happens after a decision.

Keeping NJ FamilyCare Coverage Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, NJ FamilyCare must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.17 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it.17 That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, New Jersey may offer the same windows but is not required to, so ask your county welfare agency what applies to you.17

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).17

Return a renewal form the week it arrives. See New Jersey Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Learn More

Find personalized help understanding New Jersey Medicaid and MLTSS at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.