Medicaid and How To Enroll

January 06, 2023

This article is a part of our
Health Insurance and Autism series.


COMING SOON!

Enrolling Your Child in Medicaid

Medicaid is a joint federal and state program under which the government pays for beneficiaries’ health costs. New Jersey has named its Medicaid program NJ FamilyCare. As part of the Medicaid EPSDT Benefit, NJ FamilyCare must cover all medically necessary services to correct or lessen a child’s behavioral deficits and conditions. As a result, NJ FamilyCare covers all medically necessary ABA, occupational, physical, and speech therapies for beneficiaries under the age of 21.

This article will help you understand who is eligible for New Jersey Medicaid/NJ FamilyCare and how to apply. If your child already has Medicaid coverage, visit this article on how to get started with ABA therapy.

If you feel that you face an unreasonable delay when trying to access ABA therapy for your Medicaid-covered child, read our article titled Treatment When You Need It.

Who Is Eligible?

Eligibility is based on family income.

Children 18 and under are eligible for Medicaid, as long as their family’s income does not exceed 355% of the Federal Poverty Level ($8,120 per month for a family of four in 2022). You can find a chart with the full income chart by visiting the NJ FamilyCare eligibility page.

Some other states waive their income requirements for children who have a developmental disability like autism. New Jersey does not. Children with autism cannot get NJ FamilyCare unless their parents’ income falls below the maximum level set by Medicaid.

What If I Also Have Commercial (Employer-Sponsored) Insurance?

Families who have another source of health insurance, such as an employer-sponsored plan, can still get Medicaid coverage under NJ FamilyCare, as long as they meet the program’s other eligibility criteria. Once you get covered, NJ FamilyCare will automatically be considered your secondary insurer, which means doctors, therapists, and providers must bill your commercial insurance first before submitting the rest of the bill to Medicaid.

How Can I Enroll in Medicaid/NJ FamilyCare?

  1. Apply Online – This is the fastest way to complete your application. Select the “Start New Application” option under New Client to get started.
  2. Apply By Phone – You can also apply by phone by calling 800.701.0710. The NJ FamilyCare representative who answers that number can also help troubleshoot problems you might have with your online application.
  3. Appy In Person – Visit the NJ FamilyCare website to find a list of in-person enrollment sites. Select your county from the drop-down menu to get started. Due to COVID-19 crisis, some offices may not be open. NJ FamilyCare advises applicants to call before visiting.

Need Help?

If you can’t figure out what type of health insurance you have, or if you have other questions about insurance and how to use it to cover autism diagnostic evaluations or applied behavior analysis, visit our insurance hub.

Connect with an Autism New Jersey Helpline Specialists. Call 800.4.AUTISM Helpline or email information@autismnj.org.