New Jersey residents who lose NJ FamilyCare in 2026 are usually surprised, because most terminations come from paperwork rather than a change in need. A missed renewal form, a returned letter at an old address, or income that rose above the 2026 limit can all end coverage within a single billing cycle. The loss is a qualifying life event, and it unlocks a 60-day Special Enrollment Period (SEP) on Get Covered NJ, the state-run Marketplace that replaced healthcare.gov for New Jersey in 2021. Within that 60-day window you can buy a private plan with premium tax credits, and you can ask NJ FamilyCare to reconsider at any time. Federal rules from medicaid.gov and healthcare.gov protect both paths, and KFF's Marketplace enrollment guide confirms that loss of Medicaid or CHIP is a standard SEP trigger. The order matters: read the notice, check whether you still qualify for NJ FamilyCare, and only then shop Marketplace plans, so you never pay for coverage you could have received free. This page walks through the exact dates, the 2026 income limits, the documents you need, and the mistakes that leave New Jersey families uninsured. Every number below is tied to 2026 rules unless a different year is stated.
Three decisions drive the outcome after a New Jersey Medicaid loss in 2026. First, decide whether to contest the termination: a fair hearing request filed within 10 days of the termination can keep coverage active during the appeal, and a written request is generally due within 20 calendar days of the notice date. Second, decide whether you qualify to reapply. In 2026, NJ FamilyCare covers adults ages 19 to 64 at or below 138% of the federal poverty level, children in households with much higher incomes, and pregnant New Jerseyans up to 205% FPL, so a family that lost coverage because one parent got a raise may still have children eligible for CHIP. Third, decide how to bridge any gap with a Get Covered NJ plan, a COBRA election, or a spouse's employer plan. The Marketplace SEP is the safest backstop, since a plan selected by day 60 starts coverage soon after, while Medicaid applications can run alongside it. Use the household table below to see where your 2026 income lands, and use the screener to confirm your path.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
Most New Jersey families who go uninsured after a Medicaid loss in 2026 make one of these five mistakes:
- Shopping the Marketplace before checking NJ FamilyCare. Medicaid is free in 2026 if income is at or below 138% FPL, while Marketplace plans carry premiums and deductibles.
- Ignoring a termination notice because the deadline looks far away. The 10-day and 20-day appeal clocks run from the notice and termination dates, not from when you read the letter.
- Reporting last year's income to Get Covered NJ. Premium tax credits use projected 2026 income, and a figure above 400% FPL ($63,840 for one person in 2026) removes federal credits.
- Letting the 60-day SEP lapse while waiting for a Medicaid decision. File the Marketplace application before day 60 and cancel it later if NJ FamilyCare is approved.
- Forgetting the children. NJ FamilyCare CHIP covers children at income levels far above the adult 2026 Medicaid limit, so parents can lose coverage while kids still qualify.
NJ FamilyCare Medicaid Eligibility After Losing Coverage in 2026
New Jersey's NJ FamilyCare program covers more people than most families realize, so a termination in 2026 is often reversible. New Jersey expanded Medicaid under the ACA, which means in 2026 that adults ages 19 to 64 qualify at or below 138% of the federal poverty level: $22,025 a year for one person and $45,540 for a family of 4 in 2026. Children qualify at far higher incomes through NJ FamilyCare CHIP, and pregnant residents qualify up to 205% FPL under the 2026 DMAHS standards. Apply through njfamilycare.dhs.state.nj.us, by phone at 1-800-701-0710, or at your County Board of Social Services, and read the federal rules at medicaid.gov. Two 2026 details matter. First, eligibility uses current monthly income, so a layoff or reduced hours can restore eligibility even if last year's income was high. Second, federal law enacted in 2025 adds work requirements and six-month renewals for expansion adults beginning no later than January 1, 2027, per KFF analysis, so keep your address and phone number current with NJ FamilyCare to avoid paperwork terminations.
Appeals and Reconsideration for NJ FamilyCare Terminations in 2026
New Jersey gives you two separate ways to contest a NJ FamilyCare termination in 2026, and the clocks differ. A fair hearing is the formal appeal: send a written request to the DMAHS Fair Hearing Unit, P.O. Box 712, Trenton, NJ 08625, or by fax to 609-588-2435, so it arrives within 20 calendar days of the notice date, and keep proof of delivery. A request filed within 10 days of the termination effective date can keep benefits in place during the appeal under N.J.A.C. 10:49-10.4, although you may owe repayment if you lose. Reconsideration is the second path for people terminated because of missing renewal paperwork: federal rules at medicaid.gov require states to allow a reconsideration period of at least 90 days after termination, during which returning the missing documents can restore coverage without a brand new application. DMAHS also ended several pandemic-era fair hearing flexibilities on June 30, 2026, so confirm current deadlines on your notice. Free help is available from Legal Services of New Jersey and the Community Health Law Project. Appealing does not replace the Marketplace SEP, so enroll on Get Covered NJ before day 60.
How Get Covered NJ Differs From HealthCare.gov in 2026
New Jersey residents buy Marketplace coverage through Get Covered NJ, the state-based exchange at GetCovered.NJ.gov, rather than healthcare.gov. The federal Marketplace SEP rules from healthcare.gov still set the baseline: loss of Medicaid or CHIP is a qualifying life event, and the standard window is 60 days. Federal premium tax credits apply in New Jersey, and the state adds its own savings for eligible residents, so compare the final premium in the Shop and Compare tool instead of relying on federal estimates. Silver plans carry cost-sharing reductions for household income up to 250% of the federal poverty level, which lowers deductibles and copays in 2026. The enhanced federal credits expired January 1, 2026, so the 400% FPL cliff ($63,840 for one person in 2026) is back and premiums rose for many households. Get Covered NJ mails Form 1095-A each January, and you must reconcile the credits on your federal tax return. Open enrollment for 2027 coverage begins November 1, 2026, so anyone whose SEP window closes near that date should compare 2027 plans as well.
Frequently Asked Questions
What is the SEP window after losing NJ FamilyCare in 2026?
The Marketplace Special Enrollment Period lasts 60 days from the date your NJ FamilyCare coverage ends. If your coverage ends October 31, 2026, you can enroll on Get Covered NJ from November 1 through December 30, 2026, and you may choose a plan up to 60 days before the loss if your notice arrived early. Select a plan by the last day of the window to avoid a coverage gap. Medicaid itself has no deadline, so you can reapply for NJ FamilyCare at any time. Confirm your exact dates with Get Covered NJ at 1-833-677-1010, because the state-based Marketplace sets its own rules within federal limits published at healthcare.gov.
How do I document the loss of NJ FamilyCare for the SEP?
Keep your NJ FamilyCare termination notice showing the end date, since it is the strongest proof of the qualifying life event. Get Covered NJ may accept your attestation for loss of Medicaid or CHIP, but upload the notice if asked. Also gather pay stubs or an unemployment letter for projected 2026 income, Social Security numbers for everyone applying, and proof of New Jersey residency. If you never received a notice, call NJ FamilyCare at 1-800-701-0710 or your County Board of Social Services and request a copy of the termination record. Save a screenshot of your Get Covered NJ confirmation page and your plan selection date for your files.
What if I miss the 60-day SEP window?
Missing the 60-day Marketplace SEP usually means waiting for the next open enrollment period, which begins November 1, 2026 for 2027 coverage, and going uninsured until then unless another qualifying life event occurs. New Jersey residents can still apply for NJ FamilyCare at any time, so a missed Marketplace window does not block Medicaid. Check your income against the 2026 table on this page, because a drop in household income may restore Medicaid eligibility. Some people qualify for an exception when a notice was delayed or a system error occurred, so call Get Covered NJ and ask about a late enrollment request with documentation of the problem.
Can I get retroactive coverage after losing NJ FamilyCare?
Retroactive coverage depends on the program. A Get Covered NJ plan starts on a future date, usually the first of the month after you pick a plan, so a Marketplace SEP does not cover bills from days you were uninsured. NJ FamilyCare can be different: if you win a fair hearing or the state reinstates coverage after reconsideration, your coverage is restored back to the termination date. A new NJ FamilyCare application can also reach back up to three months before the application month if you were eligible and had medical bills, per federal Medicaid rules at medicaid.gov. Ask NJ FamilyCare to review retroactive eligibility when you apply.
What is the difference between COBRA and the Marketplace after losing Medicaid?
COBRA continues a former employer group plan and charges 102% of the full premium, typically $400 to $900 a month for one person in 2026, and it only applies if you also lost job-based coverage. Marketplace plans on Get Covered NJ use federal premium tax credits plus New Jersey savings, and many lower-income enrollees pay about $10 a month or less in 2026. Medicaid loss alone does not create a COBRA right, because COBRA attaches to employer plans. If you have both, you have 60 days to elect COBRA and 60 days for the Marketplace SEP, and the IRS COBRA guidance at irs.gov explains the election rules. Compare costs before electing.
What New Jersey rules apply when I lose NJ FamilyCare?
New Jersey rules differ from federal defaults in four ways. Marketplace enrollment runs through Get Covered NJ at GetCovered.NJ.gov, not healthcare.gov. Medicaid and CHIP are branded NJ FamilyCare and managed by the Division of Medical Assistance and Health Services (DMAHS). A written fair hearing request is generally due within 20 calendar days of the notice date, and 10 days from termination preserves benefits during the appeal under N.J.A.C. 10:49-10.4. New Jersey also expanded Medicaid, so adults at or below 138% FPL ($22,025 for one person in 2026) qualify. Verify your notice for the controlling dates, because individual notices state the exact deadlines for your case.
Do I qualify for NJ FamilyCare again after losing it?
Qualifying again depends on current household income. For 2026, adults ages 19 to 64 qualify at or below 138% FPL: $22,025 a year for one person, $29,863 for two, $37,702 for three, and $45,540 for a family of 4. Pregnant residents qualify up to 205% FPL in 2026, and children qualify at much higher income levels through CHIP. Medicaid counts current monthly income, so a layoff, reduced hours, or a new baby can restore eligibility. Use the household table on this page or the CoveredUSA screener, then apply at njfamilycare.dhs.state.nj.us. If you are above the 2026 limit, a Get Covered NJ plan with subsidies is your next step.
What happens to my children's coverage if I lose NJ FamilyCare?
Children often keep coverage even when a parent loses it, because NJ FamilyCare CHIP covers children at much higher income levels than the 2026 adult Medicaid limit of 138% FPL. Check each child's status separately and enroll children through njfamilycare.dhs.state.nj.us, since CHIP enrollment is year-round with no SEP deadline. Premiums, if any, are low and based on family income in 2026. If a child is not eligible, the child can join the family's Get Covered NJ plan during the 60-day Marketplace SEP. Review the CHIP rules at medicaid.gov and keep the termination notice for every household member in case a hearing is needed.
