The Vindicator Explains: New NJ FamilyCare rules are coming. What you need to know.

What’s changing?

Many adults enrolled in the Alternative Benefit Plan will have to complete 80 hours per month of qualifying activities or meet an exemption.

Children and most people enrolled through NJ FamilyCare’s Aged, Blind, and Disabled program will continue to renew annually and will not be subject to the activity requirement.

The state may ask affected members for documents if it cannot independently verify that they met the activity requirement or qualified for an exemption.

Documentation requirements will depend on the type of activity or exemption and guidance issued by New Jersey. Members should continue checking the state’s website because some implementation details could change.

How do I know if I have the Alternative Benefit Plan?

Check your NJ FamilyCare health plan identification card for “ABP” or “Alternative Benefit Plan.”

If you do not see either term or are unsure which plan you have, call the member-services number on the back of your card.

Why is Medicaid changing?

President Donald Trump signed his signature tax and spending bill, known as H.R. 1 or the “One Big Beautiful Bill Act,” into law on July 4, 2025.

The law cuts taxes, reduces federal spending on Medicaid and the Supplemental Nutrition Assistance Program, commonly called SNAP, and makes other changes to the federal budget.

The Congressional Budget Office estimated that the law will increase federal deficits by approximately $4.1 trillion from 2025 through 2034, including additional interest costs.

A Congressional Budget Office analysis estimated that households in the bottom 10% of the income distribution will lose approximately $1,200 in annual resources, largely because of reductions in federal benefits. Households in the top 10% will gain an estimated $13,600 annually, largely because of tax cuts.

The New Jersey Department of Human Services estimates that approximately 540,000 NJ FamilyCare members receive coverage through Medicaid expansion and could be affected by the new rules.

Some will be exempt from the activity requirement, although many exempt members may still have to renew their coverage every six months.

The department estimates that more than 300,000 NJ FamilyCare participants could lose coverage because of the law’s eligibility changes.

How can I prepare?

NJ FamilyCare plans to contact affected members by fall 2026.

If you think the activity requirement will apply to you, save pay stubs, records of your work hours, or documents showing participation in eligible education, job training, or community service programs.

The state’s NJ FamilyCare Activity Requirements Checker can help you determine whether the new rules may apply to you or whether you may qualify for an exemption.

Which noncitizen immigrants could lose coverage?

Beginning Oct. 1, 2026, some noncitizen immigrants may no longer qualify for NJ FamilyCare because of changes in federal eligibility rules.

Groups that may no longer qualify include some:

• Refugees.
• Asylees.
• Humanitarian parolees.
• Victims of domestic violence or human trafficking.

People in these categories who have become lawful permanent residents, commonly called green card holders, may still qualify.

Other groups that may continue to qualify include:

• Lawful permanent residents who meet applicable requirements.
• Cuban and Haitian entrants.
• Migrants covered by the Compacts of Free Association, including people from Micronesia, the Marshall Islands, and Palau.
• Lawfully present pregnant people.
• Lawfully present noncitizens younger than 21.
• Children younger than 19, regardless of immigration status.

Immigration eligibility rules are complicated, and eligibility may depend on when and how a person received their status.

The state has published a more detailed list of noncitizens who may or may not continue to qualify.

What counts toward the activity requirement?

Affected members can meet the requirement through one activity or a combination of qualifying activities.

Paid employment

Paid employment and self-employment count. Monthly earnings equal to at least 80 hours at the federal minimum wage can also satisfy the requirement.

Job training

Participation in certain work or job-training programs can count. SNAP Employment and Training and qualifying programs funded through the Workforce Innovation and Opportunity Act may also satisfy the requirement.

Education

Enrollment at least half time in a qualifying educational program counts. This can include college, vocational education, technical education, and certain other educational programs.

Community service

Community service through a public agency or nonprofit organization can count. If you are unsure whether a program qualifies, ask the organization and the agency handling your NJ FamilyCare eligibility.

Who is exempt from the activity requirement?

Some Alternative Benefit Plan members will not have to meet the activity requirement. They include:

• Pregnant people and those receiving postpartum Medicaid coverage.
• People who are medically frail or have special medical needs that significantly impair their ability to meet the requirement.
• Veterans with a total disability rating from the Department of Veterans Affairs.
• Parents, guardians, caretaker relatives, or family caregivers of a dependent child age 13 or younger or a person with a disability.
• Current and former foster youth younger than 26.
• American Indians and Alaska Natives who meet federal definitions.
• People who are incarcerated and certain people who were incarcerated during the previous three months.
• People enrolled in Medicare.
• People meeting SNAP work requirements.
• Participants in drug or alcohol rehabilitation or treatment programs.

People younger than 19 or older than 64 are not subject to the activity requirement.

Possible short-term hardship exceptions

New Jersey may choose to offer short-term hardship exceptions in certain circumstances. These could include people:

• Receiving inpatient hospital, nursing-home, or similarly intensive medical care.
• Traveling outside their communities for necessary medical treatment that is unavailable locally.
• Living in counties affected by qualifying emergencies or disasters.
• Living in counties with unemployment rates of at least 8% or 1.5 times the national unemployment rate, whichever is lower.

Who is considered medically frail?

People with a condition that significantly impairs their ability to meet the 80-hour monthly activity requirement may qualify as medically frail or as having special medical needs.

Federal rules identify several broad categories, including:

• People who are blind or have a disability.
• People with substance use disorders.
• People with disabling mental health conditions.
• People with physical, intellectual, or developmental disabilities.
• People with serious or complex medical conditions.

The specific documentation required will depend on the person’s circumstances and guidance from NJ FamilyCare.

Potentially helpful records include medical records, letters from clinicians, and treatment-program records.

The New Jersey Reentry Corporation has advised people seeking an exemption to preserve records showing their diagnosis, treatment, disability, or other qualifying circumstances.

At a meeting with service providers, the organization said telehealth appointments may be acceptable for obtaining some medical documentation. That has not been confirmed as final state policy and could change as the rules are implemented.

How will NJ FamilyCare determine whether I meet the requirement?

The state must first try to determine whether an affected member has met the activity requirement or qualifies for an exemption using reliable information it already has.

That could include payroll data, Medicaid claims or encounter records, and information about participation in education or job-training programs.

If the state cannot verify that someone met the requirement or was exempt, it must send the person a notice of noncompliance. The member will then have 30 calendar days after receiving the notice to provide proof or show that the requirement does not apply.

Coverage must continue during that 30-day period for someone already enrolled.

Before terminating coverage, the state must also determine whether the person qualifies for Medicaid under another eligibility category or for another health insurance affordability program.

People who lose coverage will have fair-hearing rights and may reapply for NJ FamilyCare at any time.

New Jersey administers NJ FamilyCare through the state Department of Human Services and county boards of social services. County boards process many applications and renewals and review supporting documents.

Because some documentation requirements are still being developed, communicate with the agency handling your case and respond promptly to every request.