New Medicaid Requirements Starting 2027 — What Your Practice Needs to Know
Dear Fidelis Care Provider Partner,
We are writing with an important update about upcoming changes to Medicaid that may affect your patients and your practice.
What Is Changing
A new federal law is changing eligibility for certain Medicaid members.
- Starting October 1, 2026, some non-citizen members may lose their NJ FamilyCare coverage due to new federal eligibility rules. Affected members are being contacted directly by Fidelis Care and NJ FamilyCare.
- Starting January 1, 2027, certain adult members enrolled in the Alternative Benefit Plan (ABP) will be required to renew their NJ FamilyCare coverage every 6 months.
- Starting January 1, 2027, certain adult members enrolled in the Alternative Benefit Plan (ABP) will be required to participate in work, education, job training, or community service activities for 80 hours per month to keep their coverage. Some adults ages 19–64 enrolled in the Alternative Benefit Plan (ABP) may qualify for an exemption. All others will need to complete this requirement.
Providers can help by directing patients to the NJ FamilyCare website: https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml, where they can see whether the new rules apply to them, confirm their plan type, and update their contact information.
New Jersey will define the specific program details within the federal requirements. Fidelis Care will keep you updated as state guidance becomes available.
What This Means for Your Practice
- Some patients may need to document their work, training, or volunteer activities to stay eligible.
- Patients with disabilities, serious health conditions, or caregiving responsibilities may qualify for an exemption — your team can help identify them early.
- Fidelis Care will provide guidance on clinical documentation when needed to support exemption requests.
- We are working proactively to reach members before any coverage changes occur.
How Fidelis Care Is Supporting You
- Provider Engagement: Your Fidelis Care representative will be your go-to contact for updates, talking points, and escalation support.
- Provider Call Center: Our team will have updated scripts to handle common questions about eligibility and member services.
- Community Partnerships: We connect members with local resources for job training, education, and community service.
- Website: We will publish and regularly update information on the Fidelis Care provider website.
What to Do Next
No action is required right now. We do ask that you:
- Share this update with your office managers and clinical staff.
- Contact your Fidelis Care Provider Engagement representative with any questions.
- Watch for future updates as state and federal guidance is finalized.
Thank you for the care you provide to our members-your patients. Together, we will help our communities navigate these changes with as little disruption as possible.
Sincerely,
Fidelis Care Provider Relations
Note: The “Big Beautiful Bill” (formally H.R.1, signed in 2025) is the federal law that established these Medicaid requirements.
What Is Changing
- Starting October 1, 2026, some non-citizens may no longer qualify for NJ FamilyCare/Medicaid based on new federal rules. Members whose status does not qualify will have their coverage terminated on September 30, 2026.
- Affected members include refugees, asylees, humanitarian parolees, and survivors of trafficking or domestic violence who have not adjusted to Lawful Permanent Resident status.
- Your patients can be directed to NJ Family Care website for more information, document submission, and to check their eligibility status: https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml
- Starting January 1, 2027, certain Medicaid members must complete 80 hours per month of approved activities-such as work, job training, volunteering, or school-to keep their coverage.
- This applies to Adults ages 19–64 enrolled in the Alternative Benefit Plan (ABP) who do not qualify for an exemption. Members who do not meet the requirement or fail to report their activities may lose coverage.
- Beginning January 1, 2027, certain adults ages 19 to 64 will also be required to renew their NJ FamilyCare coverage every 6 months instead of annually. This applies to members enrolled in the Alternative Benefit Plan (ABP).
- New Jersey Family Cares is rolling out the specific program details within the federal framework. Fidelis Care is working closely with state and federal partners to prepare.
- Encourage patients to open and respond to all mail from NJ FamilyCare promptly and to keep their contact information current to avoid gaps in coverage. They can do so at the NJ Family Care website: https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml.
What This Means for Your Practice
- Some Fidelis Care Members may need to show they are meeting the requirements during a coverage period. We will keep you informed and work with you as the state finalizes the details.
- Exemptions will be available for members with qualifying disabilities or caregiving responsibilities. More details will follow as guidance is issued.
- Your team can play a key role by identifying patients who may qualify for an exemption and connecting them with Fidelis Care support.
How Fidelis Care Is Supporting You
- Your Provider Engagement representative will keep you updated with talking points, FAQs, and escalation contacts as guidance evolves.
- Our provider call center will have updated scripts to handle common questions about eligibility, referrals, and member status.
- We are partnering with hospitals, community health centers, and local organizations to maintain access and network stability.
- Resources will be posted and regularly updated on the Fidelis Care provider website.
- Please contact us with any questions: 1-888-453-2534.
Key Reminders for Your Team
- Continue delivering care as normal. No changes to services are required right now.
- Our goal is to help members stay covered by understanding the requirements or accessing an exemption.
- Reach out to your Fidelis Care Provider Engagement representative with any questions.
Frequently Asked Questions (FAQs)
Q: What are the new Medicaid eligibility changes?
A: Starting October 1, 2026, some non-citizens may no longer qualify for NJ FamilyCare/Medicaid based on new federal rules. Members whose status does not qualify will have their coverage terminated on September 30, 2026.
Starting January 1, 2027, Adults ages 19–64 enrolled in the Alternative Benefit Plan (ABP) who do not qualify for an exemption complete 80 hours per month of approved activities-such as working, job training, school, or volunteering to keep their Medicaid coverage.
Beginning January 1, 2027, certain adults ages 19 to 64 will also be required to renew their NJ FamilyCare coverage every 6 months instead of annually. This applies to members enrolled in the Alternative Benefit Plan (ABP).
Q: Do I need to check whether my patients are meeting the requirements before seeing them?
A: Not at this time. Continue delivering covered services as usual. Fidelis Care will notify you if any pre-service eligibility steps change.
Q: How can my practice help patients who may qualify for an exemption to work requirements?
A: You can help by identifying patients with qualifying conditions early. Clinical documentation may be needed to support an exemption request. Fidelis Care will provide specific guidance on the process once state rules are finalized.
Q: Could these changes affect my payments or reimbursements?
A: If members lose coverage due to non-compliance, it could affect continuity of care. We are actively working to prevent this through member outreach. We will let you know right away if any billing or eligibility verification steps change.
Q: What are the new redetermination requirements, and how does this affect my patients?
A: Beginning January 1, 2027, certain adults ages 19 to 64 enrolled in the Alternative Benefit Plan (ABP) must renew their NJ FamilyCare coverage every 6 months rather than annually. NJ FamilyCare will review member information at renewal and may renew coverage automatically or send a request for additional information. Members who do not respond risk a gap in coverage. Encourage patients to watch for mail from NJ FamilyCare, respond promptly, and keep their contact information current.
Q: How can my practice help my non-citizen patients affected by these federal changes?
A: Non-citizen eligibility includes refugees, asylees, humanitarian parolees, and survivors of trafficking or domestic violence who have not adjusted to Lawful Permanent Resident status. Fidelis Care and NJ Family Care is contacting affected members directly. Please direct your patients to https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml for more information and documentation submission.
Q: Where do I find updates?
A: Updates will be posted on the Fidelis Care provider website. Your Provider Engagement representative will also communicate changes directly. You can also reference CMS State Guidance on Transformative Medicaid Reforms for background information. Please see NJ Family Care website for information: https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml.
Q: Who do I call with questions?
A: Contact your Fidelis Care Provider Engagement representative. For general inquiries, call the provider call center number listed in your provider directory.
Please see Division of Medical Assistance and Health Services website for additional information: https://www.nj.gov/humanservices/dmahs/obbba/medicaid-federal-changes.shtml