Planning for the Unwinding

Since March of 2020, NJ FamilyCare/Medicaid has followed special rules related to the federal COVID-19 Public Health Emergency (PHE). These rules have allowed most NJ FamilyCare/Medicaid members to keep their health coverage, even if they no longer qualified – for example, if their income was too high.However, Congress recently passed legislation that said state Medicaid programs have to go back to following normal federal rules on April 1, 2023.

NJ FamilyCare is going to start re-determining members’ eligibility on April 1, 2023. This means that all members enrolled in an NJ FamilyCare program will be reviewed to see if they still qualify for coverage. As part of this review, many members will receive mail from the State of New Jersey or their County Board of Social Services. Members will have to provide or confirm additional information so NJ FamilyCare/Medicaid can decide whether they still qualify for healthcare coverage. Members who do not respond to NJ FamilyCare/Medicaid mail will lose their coverage.

What is unwinding?

“Unwinding” is the process where New Jersey will restart yearly eligibility reviews for everyone enrolled in NJ FamilyCare/Medicaid. This will happen starting April 1, 2023.

What happens during unwinding?

During the unwinding, NJ FamilyCare/Medicaid will send renewal packets for members to complete and return. Then NJ FamilyCare/Medicaid will decide if members still qualify for coverage. You can learn more about who can qualify here. Members who still qualify will keep their NJ FamilyCare/Medicaid coverage.

When will NJ FamilyCare/Medicaid restart eligibility checks?

New Jersey will resume ordinary eligibility processes for everyone enrolled in NJFamilyCare/Medicaid in April 2023. At that time, NJ FamilyCare will begin checking eligibility for over 2,000,000 NJ FamilyCare members.

What can members do to prepare for the return to annual eligibility checks?

  • Call NJ FamilyCare/Medicaid at 1-800-701-0710 (TTY: 711) to update their contact information. This is especially important if they have moved in the last three years.
  • Watch for mail from the State of New Jersey or your county, and make sure to reply on time to avoid a gap in coverage.

What happens if members no longer qualify for NJ FamilyCare/Medicaid?

Members should take time to make sure the renewal process goes smoothly by responding to requests for information and reporting changes in their household like pregnancy, address, income, and so on. Those members determined to be eligible will continue to receive NJ FamilyCare/Medicaid benefits.

If a member no longer qualifies for coverage through NJ FamilyCare/Medicaid, they may be referred to GetCoveredNJ, where they can get help paying for healthcare coverage. GetCoveredNJ is the state's official health insurance marketplace where individuals and families can easily shop for and buy affordable healthcare coverage.

A member who has lost coverage but believes they still qualify should call their County Board of Social Services or the NJ FamilyCare health benefits coordinator at 1-800-701-0710 (TTY: 711).

If a member has Medicare, they may qualify for help with premiums, co-pays, and deductibles through New Jersey’s Medicare Savings Programs. Learn more about program eligibility and benefits by calling 1-609-792-9745 (TTY: 711).

How can community and provider organizations help with the unwinding process?

  • Advise NJ FamilyCare/Medicaid members to call 1-800-701-0710 (TTY: 711) to update their contact information. This is especially important if they have moved in the last three years. 
  • Share information about NJ FamilyCare/Medicaid changes and actions that members need to take to maintain NJ FamilyCare/Medicaid coverage. 
  • Check the Stay Covered NJ website frequently. This website is updated to reflect the most current FAQs and guidance. 
  • Download and share materials from the Stay Covered NJ Toolkit. 

How can healthcare providers help with the unwinding process?

  • Share information about NJ FamilyCare/Medicaid renewals in patient waiting areas, in clinical rooms, and in meetings. Hang posters and leave NJ FamilyCare information in common places. 
  • If an NJ FamilyCare/Medicaid member reports an updated address to the provider office, remind them to also call 1-800-701-0710 (TTY: 711) to update their address with NJ FamilyCare/Medicaid. 
  • Check the Stay Covered NJ website frequently. The Stay Covered NJ Toolkit is updated to reflect the most current guidance. 

How has NJ FamilyCare/Medicaid prepared for the end of the PHE?

NJ FamilyCare/Medicaid is working with managed care organizations (MCOs), County Boards of Social Services, and community partners to 

  • raise awareness, 
  • encourage members to update their contact information, and 
  • encourage members to respond to all mail from NJ FamilyCare/Medicaid. 

NJ FamilyCare/Medicaid is also working closely with GetCoveredNJ to ensure New Jerseyans have access to healthcare coverage even if they are no longer eligible for NJ FamilyCare/Medicaid.

Unwinding Process - Call to update your address Call to update your address, and get ready to receive a renewal packet.