ACA’s Medicaid eligibility expansion in New Jersey
New Jersey expanded Medicaid in accordance with the Affordable Care Act (ACA), utilizing federal funding to provide health insurance for the newly-eligible population starting in 2014.
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Due in large part to the expansion of Medicaid, the uninsured rate in New Jersey dropped from 13.2% in 2013 to 8% in 2016. However, the coronavirus/Covid-19 pandemic triggered a sharp increase in New Jersey’s uninsured rate; it was at 13% as of May 2020.
New Jersey has accepted federal Medicaid expansion
- 2,053,575 – Number of New Jerseyans covered by Medicaid/CHIP as of October 2021
- 769,724 – Increase in the number of New Jerseyans covered by Medicaid/CHIP fall 2013 to October 2021
- 40% – Reduction in the uninsured rate from 2010 to 2019
- 54% – Increase in total Medicaid/CHIP enrollment in New Jersey since Medicaid expansion took effect
New Jersey Medicaid and the Trump Administration
The Trump Administration vowed to repeal the ACA and replace it, but that did not come to pass. There were several legislative efforts to repeal or change various aspects of the ACA in 2017, including bills that would have ended the enhanced federal funding for Medicaid expansion and switched general Medicaid funding to block grants or per-capita allotments, with an overall goal of sharply cutting federal Medicaid spending. But none of those bills passed. The only part of the ACA that was repealed was the individual mandate penalty.
For New Jersey’s population that was already eligible for Medicaid prior to 2014, the federal matching rate was only 50%, but for those newly eligible for Medicaid under the ACA’s expansion, the federal government paid 100% of the costs through 2016, and is now paying 94% of the costs. As of 2020, the federal government paid 90% of costs, and the funding split remains at that level going forward.
A New Jersey Policy Perspective report warned in 2017 that 528,000 people in New Jersey (about ten percent of the non-elderly population in the state) could have lost their health coverage if Medicaid expansion had been eliminated. This included the 480,000 people who have gained coverage as a result of Medicaid expansion in New Jersey, but it also included additional people who were eligible for Medicaid in New Jersey prior to 2014 under Medicaid waivers that the state had negotiated with CMS. Those waivers have since expired, which didn’t matter once the ACA’s Medicaid expansion was in place. But if the ACA—including Medicaid expansion—had been repealed, those people wouldn’t be able to retain their Medicaid coverage in New Jersey anymore.
If the ACA had been repealed, nearly two-thirds of the adults who would have lost access to Medicaid have jobs or are in a household where someone has a job (i.e., they might be the stay-at-home parent, while the other parent works to support the family). These are the people who work in the service industry, construction, home health care, retail, and the education system. They are vital to our economy and our lives, but their employers often don’t provide coverage (or they might be in the family glitch), and their income just isn’t high enough to purchase health insurance, particularly in a high cost-of-living state like New Jersey.
Fortunately for these families and the communities where they live and work, Medicaid expansion—along with virtually all of the rest of the ACA—is still intact.
Who is eligible for Medicaid in New Jersey?
In addition to the aged, blind, and disabled, the following New Jersey residents are eligible for Medicaid:
- Adults with incomes up to 138% of poverty
- Children with household incomes up to 350% of poverty are eligible for CHIP in New Jersey. This is one of the most generous thresholds in the country.
- Pregnant women with incomes up to 200% of poverty (unchanged from 2013).
How does Medicaid provide financial assistance to Medicare beneficiaries in New Jersey?
Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in New Jersey includes overviews of these benefits, including Medicare Savings Programs, Medicaid long-term care coverage, and eligibility guidelines for assistance.
How do I enroll in Medicaid in New Jersey?
Medicaid enrollment is available year-round.
The NJ Family Care website also has paper applications that can be downloaded, although they strongly encourage online applications. They can be reached by phone at 1-800-701-0710 if applicants need assistance.
New Jersey Medicaid enrollment numbers
New Jersey has a population of about 8.8 million. In August 2020, 1,825,324 people were covered by Medicaid and CHIP in New Jersey. This figure includes about 300,000 Medicaid aged, blind, and disabled (ABD) beneficiaries, about 699,000 non-ABD adult (Medicaid expansion) beneficiaries, and 826,00 non-ABD child beneficiaries.
History of New Jersey Medicaid expansion
New Jersey was one of five states that opted to partially expand Medicaid well ahead of the 2014 start date that most states used. In New Jersey, childless adults with incomes up to 23% of poverty were able to start enrolling in Medicaid in April 2011 (as noted above, the expiration of previous waivers allowing this is part of the reason the Medicaid coverage losses in New Jersey — if the ACA were to be overturned — would exceed the number of people who have newly become eligible for Medicaid under the ACA).
This was still a very low income limit (as of 2018, 23% of poverty level was just $2,792 in annual income for a single person), but was more generous than average: More than half of the states provided no health coverage assistance at all to low-income adults without children prior to 2014, and there are 11 states as of late 2021 that still provide no assistance to childless adults living in poverty.
In February 2013, then-Governor Chris Christie agreed to accept federal funding for full Medicaid expansion, and later that year he signed a budget that included $227 million in federal Medicaid expansion funds.
But Christie’s acceptance of Medicaid expansion hinged on a provision that the state would only continue to offer expanded Medicaid as long as the federal government maintains its promise to always pay at least 90% of the cost of covering the population eligible under the expansion guidelines.
In June 2013, Christie vetoed a state bill (S2644) that would have made Medicaid expansion permanent regardless of any future changes in the federal funding rate, and NJ’s Medicaid expansion is still contingent on continued federal funding. Many other states have adopted similar provisions in their Medicaid expansion agreements.
In early 2014, Governor Christie said that he was “proud” of the state’s decision to expand Medicaid, but emphasized that more needed to be done to control costs in the $12 billion New Jersey Medicaid program.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.