New Jersey and the ACA’s Medicaid expansion

Medicaid enrollment grew by 36% in New Jersey after Medicaid was expanded

new-jersey Medicaid guide

Medicaid 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.

As a result, New Jersey’s total Medicaid enrollment increased by 36 percent—nearly 460,000 people—between the fall of 2013 and November 2017. Total Medicaid/CHIP enrollment in New Jersey as of late 2017 stood at nearly 1.75 million people.

Due in large part to the expansion of Medicaid, the uninsured rate in New Jersey dropped from 13.2 percent in 2013 to 8 percent in 2016.

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The only part of the ACA that was repealed was the individual mandate penalty, and that repeal doesn’t take effect until 2019—there is still a penalty for people who are uninsured in 2018.

For New Jersey’s population that was already eligible for Medicaid prior to 2014, the federal matching rate is only 50 percent, but for those newly eligible for Medicaid under the ACA’s expansion, the federal government paid 100 percent of the costs through 2016, and is now paying 94 percent of the costs. The federal government will be paying 90 percent of the costs by 2020, and the funding split will remain 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 has 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 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 (ie, 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?

In addition to the aged, blind, and disabled, the following New Jersey residents are eligible for Medicaid:

  • Adults with incomes up to 138 percent of poverty
  • Children with household incomes up to 350 percent 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 percent of poverty (unchanged from 2013).

How do I apply?

In New Jersey, all Medicaid coverage – including previously eligible populations as well as the population that is newly eligible under the Medicaid expansion guidelines – is handled by NJ Family Care.

Medicaid enrollment is available year-round. Applicants can apply for Medicaid via HealthCare.gov, or through the NJ Family Care online application.

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.

The decision to expand Medicaid

New Jersey was one of five states that opted to partially expand Medicaid well ahead of the 2014 state-date that most states used. In New Jersey, childless adults with incomes up to 23 percent 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 loss of coverage in New Jersey would exceed the number of people who have newly become eligible for Medicaid under the ACA).

This is still a very low income (as of 2018, 23 percent of poverty level was just $2,792 in annual income for a single person), but it’s better than nothing — 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 18 states 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 percent of the cost of covering the population eligible under the expansion guidelines.

In June 2013, Christie vetoed a state bill 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 NJ 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.

How to apply in NJ

Online at HealthCare.gov, or through the NJ Family Care online application.  You can apply by phone at 1-800-318-2596 or contact NJ Family Care for assistance at 1-800-701-0710.

Eligibility: The aged, blind, and disabled.  Also, adults with income up to 138% of poverty, and pregnant women with income up to 200% of poverty.  Children are eligible for Medicaid or CHIP with income up to 350% of poverty.

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