AWCA Resource Center
AWCA Resource Center

Medicaid Specials

Medicaid Buy-In (NJ WorkAbility)

NJ WorkAbility is a program that allows New Jersey residents with a disability who are currently working to receive full Medicaid benefits, even if their income or assets exceed the limits for standard Medicaid (NJ FamilyCare).

*SSDI recipients can also use this program to bridge the health insurance gap during the 24-month waiting period before they become eligible for Medicare.

*While Medicare eligibility is based on a 24-month period starting from the date you begin receiving SSDI, the SSDI payments themselves do not start until after a 5-month waiting period from the established onset of the disability. Therefore, the actual total waiting period is approximately 29 months from the date the disability began.

Eligibility

  • Age: 16 years or older (Individuals aged 65 or older may apply; however, the disability determination must have been established before the age of 65).
  • Disability: Must have a disability determination from the Social Security Administration (SSA) or the Medical Review Team under the DMAHS (Division of Medical Assistance and Health Services). If you are already receiving SSDI, you automatically meet the disability requirement without needing a separate determination.

     

    *Note: If you are not currently receiving SSDI, you can contact the NJ DDS (Division of Disability Services) at 1-888-285-3036 to pre-verify your eligibility.

     

  • Employment: Must be employed part-time, full-time, or self-employed (Proof of earned income is required).
  • No Asset Limit: Eligible regardless of the size of assets such as savings or stocks.
  • No Income Limit: High-income earners can join (However, premiums apply based on income level).

     

    *Income Calculation Method: Earned income and unearned income are calculated using different formulas. Since your actual premium bracket may vary based on your specific circumstances, please contact NJ DDS (1-888-285-3036) or your County Board of Social Services for an individual assessment to verify your exact eligibility and premium amounts.

     

  • Spousal Income Excluded: Eligibility and premiums are determined solely based on the applicant’s own income.

Medicaid Buy-In Premiums (2026)

Tier LevelIncome Bracket (vs. FPL)Monthly PremiumNotes
Exempt250% or lessNone ($0)If you have no unearned income (such as SSDI, interest, or investment returns), you may be exempt from premiums for annual earned income up to $80,820.
Tier 1251% – 350%$203
Tier 2351% – 450%$406
Tier 3451% – 550%$609
Tier 4551% – 650%$812
Tier 5651% – 750%$1,015
Tier 6Over 750%$1,218Maximum premium cap

* Note: The salary figures mentioned above assume zero unearned income and are examples based on the application of the earned income disregard (approximately 50%). While SSDI benefits based on your own work history are excluded from the income calculation, benefits based on others—such as a spouse’s or parent’s disability or survivors’ benefits—are counted as unearned income. Applicants are encouraged to check eligibility as unearned income (e.g., interest, investment returns, or alimony) may change your actual premium exemption threshold.

Key Benefits

  • Comprehensive Medicaid Coverage: Includes hospital bills, prescription drugs, and all other standard Medicaid benefits.
  • Managed Long-Term Services and Supports (MLTSS): It provides coverage for Personal Care Assistant (PCA) services, which are typically not covered by private insurance. The number of service hours provided is determined through an individual care assessment based on the recipient’s specific needs.
  • Job Retention Support: Even if your salary increases or you become a high-income earner, you can maintain full Medicaid coverage simply by paying the designated premium.
  • Coverage Maintenance After Job Loss: If you lose your job through no fault of your own (e.g., layoffs, business closures, etc.), your Medicaid coverage will be maintained for up to 12 months following the loss of employment.

How to Apply

  • NJHelps.gov (Benefit Screening Portal): You can pre-check your eligibility for various benefits, such as SNAP, TANF, and NJ FamilyCare, in approximately 5 to 10 minutes. Please note that the actual application must be submitted through MyNJHelps.gov.
  • NJFamilyCare.gov: ABD (Dedicated application path for NJ WorkAbility. You may apply online or in person at your local County Board of Social Services.)
  • GetCoveredNJ.gov (If you do not qualify for Medicaid, you can enroll in a private health plan through the ACA (Affordable Care Act) Marketplace and receive a Premium Tax Credit to help lower your cost.)
  • Stay Covered NJ.gov – Website for current members’ keeping coverage

Contact

Resources

Medicaid Specials