Does your agency have to file with New Jersey?
New Jersey requires entities that provide minimum essential coverage to New Jersey residents to report it to the New Jersey Division of Taxation. In practice that means:
| Your situation | Who files | What gets filed |
|---|---|---|
| Fully insured group plan | The insurer | The insurer files a 1095-B or NJ-1095 for each covered NJ resident. New Jersey tells fully insured employers to confirm with the insurer well before the deadline, and if the insurer does not file, the employer must |
| Self-insured or level-funded plan, 50+ FTE (ALE) | You, the employer | A fully completed 1095-C, 1095-B, or NJ-1095 for each full-time employee and each enrolled employee, transmitted via MFT/Axway by March 31 |
| Self-insured or level-funded plan, under 50 FTE | You, the employer | A 1095-B or NJ-1095 for each covered employee, via MFT/Axway by March 31 |
| Out-of-state agency with NJ-resident caregivers | You (or your insurer), as above | New Jersey applies the same filing requirements to out-of-state employers and coverage providers |
New Jersey does not require 1094 transmittals and accepts the federal 1095-C with Parts I and III completed. There is no paper option; transmission is electronic through the MFT/Axway system, which requires registering in advance.
New Jersey deadlines and penalties
| Date | Obligation | Applies to | Penalty |
|---|---|---|---|
| March 2 | Furnish a 1095 to each primary enrollee who was a NJ resident | Employers (self-insured) or insurers | New Jersey has not published a penalty for late or missed furnishing |
| March 31 | Transmit 1095 data to the Division of Taxation via MFT/Axway | Employers (self-insured) or insurers | New Jersey has not published a fixed per-form penalty. The Division of Taxation enforces the requirement, and an employer whose insurer fails to file is itself required to file |
New Jersey's Treasury has published deadlines and file formats but no penalty schedule for coverage providers, and HUB International's January 2026 state-reporting bulletin confirms none has been specified. Treat the filing as a hard requirement anyway: it is mandated by the Health Insurance Market Preservation Act, the Division of Taxation uses the data to verify residents' coverage on their returns, and if your insurer misses the deadline the obligation falls to you.
Is your agency an Applicable Large Employer?
Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.
Worked example. A New Jersey agency has 40 caregivers and office staff at 130+ hours a month, plus 24 part-time caregivers averaging 50 hours a month.
- Full-time employees: 40
- Part-time FTEs: 24 × 50 = 1,200 hours ÷ 120 = 10
- Total: 50 → the agency is an ALE. Fifty is the threshold, not fifty-one.
Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.
What an ALE owes if it doesn't comply (2026 amounts)
- 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on GetCoveredNJ, you owe $3,340 per full-time employee minus the first 30. In the example above: (40 − 30) × $3,340 = $33,400 a year, triggered by a single subsidized caregiver.
- 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.
Which New Jersey caregivers can actually trigger a penalty
Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:
| Caregiver household income | Can they get a marketplace subsidy? | Can they trigger a penalty for you? |
|---|---|---|
| Below 138% FPL | No. New Jersey expanded Medicaid, so adults to 138% FPL qualify for Medicaid and cannot receive a marketplace credit | No |
| 138%–400% FPL | Yes | Yes — each one is a potential $5,010 (b) trigger, or the single trigger for the (a) penalty |
| Above 400% FPL | Generally no in 2026, now that the enhanced credits have expired | No |
New Jersey expanded Medicaid (NJ FamilyCare); adults to 138% FPL qualify. kff.org ↗
New Jersey runs its own exchange, GetCoveredNJ, and layers state premium subsidies (NJ Health Plan Savings) on top of federal tax credits, cushioning some of the 2026 enhanced-credit expiration. nj.gov ↗
What counts as "affordable" for a New Jersey caregiver in 2026
Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:
| Safe harbor | How it's calculated | 2026 monthly ceiling for a New Jersey caregiver |
|---|---|---|
| Federal poverty line | FPL × 9.96% ÷ 12 | $129.89 regardless of wage |
| Rate of pay | Lowest hourly rate × 130 hours × 9.96% | $206.13 at the $15.92 minimum (lower catch-up schedule for employers with fewer than 6 employees) |
| W-2 wages | 9.96% of Box 1 wages | Varies; known only after year-end |
The New Jersey-specific point: because the state minimum wage is $15.92, the rate-of-pay safe harbor gives New Jersey agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $15.92 can charge up to $206.13 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.
A CHOICE (formerly known as ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on GetCoveredNJ for their rating area, minus your monthly allowance, stays within the 9.96% test.
IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the New Jersey wage & hour page
2026 compliance calendar: New Jersey and federal together
| Date | Obligation | Who | Authority |
|---|---|---|---|
| Ongoing | Track caregiver hours under your measurement/stability periods | ALEs | IRS |
| Mar 2, 2026 | Furnish Form 1095-C to full-time employees, or post a website notice and furnish within 30 days on request | ALEs | IRS |
| Mar 31, 2026 | E-file Forms 1094-C/1095-C with the IRS (e-filing required at 10+ returns) | ALEs | IRS |
| Mar 2, 2026 | Furnish 1095s to NJ-resident enrollees | Self-insured employers; insurers | NJ Treasury |
| Mar 31, 2026 | Transmit 1095 data via MFT/Axway | Self-insured employers; insurers | NJ Treasury |
The New Jersey rows apply to self-insured/level-funded sponsors (and to every employer for any item marked as such above); the IRS rows apply to ALEs. If you also employ caregivers who live in other reporting states under a self-insured plan, see the state-by-state ACA hub.
Other New Jersey benefit mandates that touch home care agencies
These aren't ACA rules, but they land on the same desk.
- TDI + Family Leave Insurance. New Jersey requires Temporary Disability Insurance (employer- and employee-funded) and Family Leave Insurance (employee-funded, up to 12 weeks); agencies must run both through payroll or an approved private plan. myleavebenefits.nj.gov ↗
- RetireReady NJ - threshold cut to 10+. The Secure Choice mandate originally covered employers with 25+ employees (registration deadlines in 2024). A January 2026 law (P.L. 2025, c.379 / A5358) extends RetireReady NJ to employers with 10 or more employees that have been in business 2+ years and lack a retirement plan. nj.gov ↗
- Small-employer continuation. New Jersey's small-employer continuation law lets employees of insured groups with 2-19 employees continue coverage for up to 18 months (36 in some cases), mirroring COBRA for agencies below the federal threshold. nj.gov ↗
Frequently asked questions
We're a Pennsylvania agency with caregivers who live in New Jersey. Do we file with New Jersey?
If those caregivers are covered under a self-insured plan, yes. New Jersey applies the same requirements to out-of-state employers as to in-state ones.
Our plan is fully insured. Are we done?
The insurer files, but New Jersey's guidance says to confirm with the insurer in advance and that the employer must file if the insurer doesn't. Get written confirmation each year.
Is there a New Jersey penalty for missing the March 31 deadline?
New Jersey hasn't published one. Treasury's guidance sets deadlines and formats without a penalty schedule. It is still a legal requirement, the Division of Taxation cross-checks the data against residents' returns, and if your insurer doesn't file, you must.
We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?
Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.
Can a caregiver on Medicaid trigger a penalty against us?
No. Penalties are triggered only by full-time employees who receive a marketplace premium tax credit. New Jersey caregivers below 138% FPL qualify for Medicaid instead, so they can't trigger 4980H. Caregivers between 138% and 400% FPL can.
We pay the New Jersey minimum of $15.92. What's the most we can charge for self-only coverage?
Under the rate-of-pay safe harbor, $15.92 × 130 hours × 9.96% = $206.13 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for New Jersey agencies.
Not legal advice. Confirm details with the cited official sources or counsel. Full disclaimer
- https://myleavebenefits.nj.gov/employer/
- https://www.hubinternational.com/products/employee-benefits/compliance-bulletins/2026/01/state-health-insurance-reporting-requirements-and-deadlines-2025/
- https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees
- https://www.irs.gov/affordable-care-act/employers/information-reporting-by-applicable-large-employers
- https://www.irs.gov/newsroom/health-reimbursement-arrangements-hras
- https://www.irs.gov/pub/irs-drop/rp-25-25.pdf
- https://www.irs.gov/pub/irs-drop/rp-25-26.pdf
- https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/
- https://www.nj.gov/dobi/division_insurance/ihcseh/sehmain.htm
- https://www.nj.gov/getcoverednj/
- https://www.nj.gov/treasury/njhealthinsurancemandate/employers.shtml
- https://www.nj.gov/treasury/securechoiceprogram/employers/employer-program-details.shtml