Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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New Jersey program

Government health insurance for your child (NJ FamilyCare)

New Jersey's free health insurance for children under 19 (NJ FamilyCare). Your child can have it alongside work insurance.

What it is

New Jersey's free health insurance for children under 19 (NJ FamilyCare). Your child can have it alongside work insurance.

NJ FamilyCare covers children whose household income fits its Medicaid rules. A drop in pay can change that result. The state decides who belongs in your child's household and which income counts.

Eligibility rules
  • Your child must live in New Jersey and be under 19. A child's immigration status does not affect eligibility.
  • The test uses current monthly income. Annual income divided by 12 is only an estimate after a pay change.
  • Free Medicaid for a child runs to about $4,043 a month for a family of four (January 2026). Above that, the same application checks the CHIP bands, which reach much higher.
  • NJ FamilyCare has several children's categories. The hospital's eligibility specialist can tell you which one your child fits and whether it sits behind your work plan.
Why consider this with work insurance?
  • NJ FamilyCare can be secondary coverage while your work plan pays first.
  • There is no child premium, so adding it does not bring a second monthly insurance charge.
  • Your hospital counselor can check the cancer team, pharmacy and billing arrangements before you decide.
What keeping two plans involves
  • The work-plan premium remains a cost, and the clinic needs both insurance cards.
  • The plans can have different networks and rules for treatment approval. A coverage award does not settle every bill.
What you get
  • No premium or child copays for covered care.
  • Hospital care, chemotherapy and medicines for your child.
  • Home nursing and rides when your child meets the service rules.
  • Help with eligible unpaid bills from earlier months.
What the help covers
  • Private insurance can stay in place while NJ FamilyCare provides secondary coverage.
  • Home nursing requires a separate review of medical need. A coverage award does not establish the number of nursing hours.
  • When private insurance is primary, it is billed first. For a covered, properly authorized service from a provider enrolled in NJ Medicaid, the provider generally may not bill you the private plan’s deductible, copay or coinsurance—even when Medicaid’s calculation pays nothing extra. This protection does not make noncovered care covered; advance private-pay arrangements, direct insurance payments and any permitted NJ FamilyCare cost sharing need their own check.
  • Example: the private plan allows $5,000 and pays $2,000 after a $3,000 deductible. Medicaid's allowance is $1,500, so Medicaid pays nothing extra. For covered, properly authorized care from an enrolled provider, the family still owes $0 under the billing protection. This example does not decide the private plan's deductible ledger or exceptions such as noncovered care.
If you decide to apply
  1. You can ask the hospital financial counselor to help with the NJ FamilyCare application online or by phone.
  2. For that discussion, it helps to have current income information, insurance details and earlier unpaid bills ready. Explain any recent pay change.
  3. You can ask the counselor which NJ FamilyCare plans your child's cancer team accepts.

NJ FamilyCare: 1-800-701-0710 · Official page ↗

After you ask
  • A hospital financial counselor can discuss temporary coverage while the full application is reviewed.
  • Children generally receive 12 months of continuous coverage from January 1, 2024. Temporary presumptive coverage and Medically Needy do not use that rule.
  • Eligible Medicaid bills from up to three months before applying can qualify through 2026. Each month must meet the eligibility rules. Federal rules reduce the period to two months for children applying from January 2027. The counselor can confirm NJ's implementation and which earlier months qualify. CHIP has separate benefits and start-date rules.
  • Ordinary applications generally have a 45-day decision standard. Applications requiring a disability determination generally have 90 days, with documented exceptions. Missing that date does not mean automatic approval. An approved hospital or other qualified organization can decide temporary presumptive eligibility. With a timely full application, it lasts until that application is decided. Without one, it ends on the last day of the following month.
  • A managed-care appeal generally has a 60-calendar-day filing window. The decision standard is 30 days, or 72 hours for urgent review. Continuing an existing authorized service has a separate, shorter request deadline. It does not start a newly denied service. Your social worker can help check the notice and request continuation in writing. A Medicaid fair hearing generally has a 120-day window after the internal appeal decision. Optional outside review does not restart it. CHIP-only members have a different route. A losing hearing decision can require repayment for continued services.
Good to know

Work insurance gets billed first. Having two plans means the hospital and pharmacy need both insurance cards.

Other details
  • One application checks both Medicaid and CHIP. You do not need to choose the income category yourself.
  • Keeping both plans preserves access through your work plan but leaves its premium to pay. The counselor can compare the exact hospital, oncology group and pharmacy networks before any coverage change.

Federal background: Medicaid and Medicaid as second insurance.

Official sources
Ask your social worker

“Could NJ FamilyCare lower our child's treatment bills alongside our insurance? What would managing two plans involve, and could you help us apply if it makes sense?”

Why I’m asking: I want to understand whether free coverage could reduce our costs without disrupting treatment.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File at njfamilycare.org today with this month's income for everyone in the tax household. Name the months that already have bills and pick a plan the oncology group takes.

Your social worker

The oncology social worker or financial counsellor helps you file, asks a participating provider to open presumptive eligibility that day, and chases the decision.

The care team

Nothing for ordinary child coverage. Medical records matter only for the nursing-level route.

Who decides
The state Division of Medical Assistance and Health Services checks income; the health plan you choose runs the coverage.
Ask your social worker
“Can you help me apply at njfamilycare.org today and open presumptive eligibility while we wait? Can we list bills from the three months before, and check the hospital and the oncology group are in the plan?”

How to apply

First step: Apply at njfamilycare.org or call 1-800-701-0710 this week. Ask the hospital counsellor today to open presumptive eligibility while the state checks the application.

  1. Apply at njfamilycare.org this week; one application covers both the Medicaid and the CHIP columns.
  2. Ask the hospital financial counsellor to open presumptive eligibility today while the state decides.
  3. List the months that already have unpaid bills so the three-month look-back covers the admission.
  4. Pick a health plan the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply at njfamilycare.org or call 1-800-701-0710. Ask the hospital's financial counsellor to open presumptive eligibility the same day.

What to gather

  • Child's birth certificate or ID and Social Security number if there is one
  • A New Jersey address
  • This month's income for each parent in the tax household (recent pay stubs)
  • Insurance cards, if any
  • Hospital bills from the three months before the application

How long: The 2022 memorandum gives the state 45 days, or 90 on a disability basis. Presumptive eligibility from a participating provider can start the same day. Once approved, a child keeps 12 months.

What a yes looks like

A notice with coverage dates and a choice of NJ FamilyCare health plan. Check the hospital and the oncology group are in that plan before choosing.

What a no looks like, and the next move

Read whether the state said no on income, a document or a category. If income is the reason, ask whether the child fits the CHIP columns of the same chart, and appeal by the date on the notice.

Watch out

  • One application at njfamilycare.org covers both the Medicaid and the CHIP columns. Do not apply twice.
  • Your child can keep private insurance and have NJ FamilyCare too. Do not cancel the work plan to apply.
  • The state chart does not say which column applies to which age. Give the child's age and let the caseworker place them; ask which column they used.

Dates that change this

2026-01-01: The income lines are the state's January 1, 2026 standards. The date the next table is adopted was not published.

2027-01-01: A federal change narrows the look-back for applications made from January 1, 2027. New Jersey has not published how it will apply that; ask when you file. (not yet confirmed against the final rule)

2026-01-01: The state chart does not say which income column applies to which age band. The site screens on the top published child Medicaid column; the caseworker may use a lower one for an older child. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full NJ FamilyCare with no premium. For four people the published child Medicaid line is $3,905 a month, or $4,043 with the five-point allowance; NJ FamilyCare continues to $9,763 for four.

  • $4,043/month — Children's Medicaid MCHIP-A, family of 4, published line with the five-point allowance (147%)
  • $3,905/month — Children's Medicaid MCHIP-A, family of 4, published base line (142%)
  • $3,347/month — Children's Medicaid MCHIP-A, family of 3, published line with the allowance (147%)
  • $2,943/month — Children's Medicaid-A, family of 4, published base line (107%)

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, without ordinary limits on how much or how long · Private-duty nursing and personal care at home when approved · Rides to appointments through the state ride service · Dental and vision

Legal protection: 12 months of continuous coverage once a child is approved

What it costs the family: No premium. No copays for children.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI household; published child Medicaid columns 107% and 142% / 147% FPL (the starred column includes the five-point allowance). The state did not publish the assignment of columns to age bands
Insurance status condition
none for Medicaid: NJ FamilyCare is secondary to private insurance and a beneficiary with other coverage may still enrol in a plan
Residency
New Jersey; a child's immigration status does not affect eligibility
Continuous eligibility
12 months for children under 19 (since January 1, 2024); presumptive eligibility and Medically Needy are excluded
Retroactive months
3 for a member with qualifying unpaid bills; the retroactive period sits outside the 12 continuous months
Processing standard
45 days, or 90 days on a disability basis (2022 memorandum; a newer one was not found)

Decisions this site cannot make: NJ FamilyCare MAGI determination · Presumptive eligibility opened by a participating provider

Expect friction on: Choosing an NJ FamilyCare health plan the oncology group takes

The trap: New Jersey publishes one chart with a Medicaid column and CHIP columns; one application at njfamilycare.org covers both, so do not apply twice. Do not cancel private insurance to apply: NJ FamilyCare pays behind it.

Where I read this

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