New Jersey § 30:4j-12

§ 30:4j-12.

a. The purpose of the program shall be to provide subsidized health insurance coverage,

and other health care benefits as determined by the commissioner, to children under

19 years of age and their parents or caretakers and to adults without dependent children,

within the limits of funds appropriated or otherwise made available for the program. The program may require families to pay copayments . The program shall include the provision of well-child and other preventive services,

hospitalization, physician care, laboratory and x-ray services, prescription drugs,

mental health services, and other services as determined by the commissioner. b. The commissioner shall take such actions as are necessary to implement and operate

the program in accordance with the State Children's Health Insurance Program established

pursuant to 42 U.S.C. s.1397aa et seq. c. The commissioner: (1) shall, by regulation, establish standards for determining eligibility and other

program requirements ; (2) shall require that a parent or caretaker who is a qualified applicant purchase

coverage, if available, through an employer-sponsored health insurance plan which

is determined to be cost-effective and is approved by the commissioner, and shall

provide assistance to the qualified applicant to purchase that coverage, except that

the provisions of this paragraph shall not be construed to require an employer to

provide health insurance coverage for any employee or employee's spouse or dependent

child; (3) may, by regulation, establish plans of coverage and benefits to be covered under

the program, except that the provisions of this section shall not apply to coverage

for medications used exclusively to treat AIDS or HIV infection; and (4) shall establish, by regulation, other requirements for the program, including,

but not limited to, copayments . Except as may be required for the NJ FamilyCare Advantage program established pursuant

to subsection j. of this section, premiums shall not be established within the program. The commissioner may contract with one or more appropriate entities, including managed care organizations,

to assist in administering the program. The period for which eligibility for the program is determined shall be the maximum

period permitted under federal law. d. The commissioner shall establish procedures for determining eligibility, which

shall include, at a minimum, the following enrollment simplification practices: (1) A streamlined application form as established pursuant to subsection k. of this

section; (2) Require new applicants to submit one recent pay stub from the applicant's employer,

or, if the applicant has more than one employer, one from each of the applicant's

employers, to verify income. In the event the applicant cannot provide a recent pay stub, the applicant may submit

another form of income verification as deemed appropriate by the commissioner. If an applicant does not submit income verification in a timely manner, before determining

the applicant ineligible for the program, the commissioner shall seek to verify the

applicant's income by reviewing available Department of the Treasury and Department

of Labor and Workforce Development records concerning the applicant, and such other

records as the commissioner determines appropriate. The commissioner shall establish retrospective auditing or income verification procedures,

such as sample auditing and matching reported income with records of the Department

of the Treasury and the Department of Labor and Workforce Development and such other

records as the commissioner determines appropriate. In matching reported income with confidential records of the Department of the Treasury,

the commissioner shall require an applicant to provide written authorization for the

Division of Taxation in the Department of the Treasury to release applicable tax information

to the commissioner for the purposes of establishing income eligibility for the program. The authorization, which shall be included on the program application form, shall

be developed by the commissioner, in consultation with the State Treasurer; (3) Online enrollment and renewal, in addition to enrollment and renewal by mail. The online enrollment and renewal forms shall include electronic links to other

State and federal health and social services programs; (4) Continuous enrollment; (5) Simplified renewal by sending an enrollee a preprinted renewal form and requiring

the enrollee to sign and return the form, with any applicable changes in the information

provided in the form, prior to the date the enrollee's annual eligibility expires. The commissioner shall establish such auditing or income verification procedures,

as provided in paragraph (2) of this subsection; (6) Provision of program eligibility-identification cards that are issued no more

frequently than once a year ; and (7) Provision of information regarding other health care programs for which an enrollee

may be eligible to any enrollee terminated from the program . e. The commissioner shall take, or cause to be taken, any action necessary to secure

for the State the maximum amount of federal financial participation available with

respect to the program, subject to the constraints of fiscal responsibility and within

the limits of available funding in any fiscal year. In this regard, notwithstanding the definition of “ qualified applicant ,” the commissioner may enroll in the program such children or their parents or caretakers

who may otherwise be eligible for the Medicaid program in order to maximize use of

federal funds that may be available pursuant to 42 U.S.C. s.1397aa et seq. f. No child who applies for enrollment in the program who otherwise meets the eligibility

criteria for enrollment shall be denied immediate enrollment for any reason. In no case shall any qualified applicant for enrollment be subject to a waiting

period prior to enrollment . g. The commissioner shall provide, by regulation, for presumptive eligibility for

the program in accordance with the following provisions: (1) A child who presents for treatment at a general hospital, federally qualified or community health center,

local health department that provides primary care, or other State licensed community-based

primary care provider shall be deemed presumptively eligible for the program if a

preliminary determination by hospital, health center, local health department or licensed

health care provider staff indicates that the child meets program eligibility standards

and is a member of a household with an income that does not exceed 350 percent of the poverty level; (2) The provisions of paragraph (1) of this subsection shall also apply to a child

who is deemed presumptively eligible for Medicaid coverage pursuant to P.L.1968, c.

413 ( C.30:4D-1 et seq. ); (3) The parent or caretaker of a child deemed presumptively eligible pursuant to this

subsection shall be required to submit a completed application for the program no

later than the end of the month following the month in which presumptive eligibility

is determined; (4) A child shall be eligible to receive all services covered by the program during

the period in which the child is presumptively eligible; and (5) The commissioner may, by regulation, establish a limit on the number of times

a child may be deemed presumptively eligible for NJ FamilyCare. h. The commissioner, in consultation with the Commissioner of Education, shall administer

an ongoing enrollment initiative to provide outreach to children throughout the State

who may be eligible for the program. (1) With respect to school-age children, the commissioner, in consultation with the

Commissioner of Education and the Secretary of Agriculture, shall develop a form that

provides information about the NJ FamilyCare and Medicaid programs and provides an

opportunity for the parent or guardian who signs the school lunch application form

to give consent for information to be shared with the Department of Human Services

for the purpose of determining eligibility for the programs. The form shall be attached to, included with, or incorporated into, the school lunch

application form. The commissioner, in consultation with the Commissioner of Education, shall establish

procedures for schools to transmit information attached to, included with, or provided

on the school lunch application form regarding the NJ FamilyCare and Medicaid programs

to the Department of Human Services, in order to enable the department to determine

eligibility for the programs. (2) The commissioner or the Commissioner of Education, as applicable, shall: (a) make available to each elementary and secondary school, licensed child care center,

registered family day care home, unified child care agency, local health department

that provides primary care, and community-based primary care provider, informational

materials about the program, including instructions for applying online or by mail,

as well as copies of the program application form. The entity shall make the informational and application materials available, upon

request, to persons interested in the program; and (b) request each entity to distribute a notice at least annually, as developed by

the commissioner, to households of children attending or receiving its services or

care, informing them about the program and the availability of informational and application

materials. In the case of elementary and secondary schools, the information attached to, included

with, or incorporated into, the school lunch application form for school-age children

pursuant to this subparagraph shall be deemed to meet the requirements of this paragraph. i. Subject to federal approval, the commissioner shall, by regulation, establish that

in determining income eligibility for a child, any gross family income above 200 percent of the poverty level, up to a maximum of 350 percent of the poverty level, shall be disregarded. j. The commissioner shall establish a NJ FamilyCare coverage buy-in program , which shall be known as NJ FamilyCare Advantage. The commissioner shall establish the premium and cost sharing amounts required to

purchase coverage, except that the premium shall not exceed the amount the program

pays per month to a managed care organization under NJ FamilyCare for a child of comparable

age whose family income is less than 350 percent of the poverty level, plus a reasonable processing fee. k. The commissioner, in consultation with the Rutgers Center for State Health Policy,

shall develop a streamlined application form for the NJ FamilyCare and Medicaid programs. l . The Commissioner of Human Services shall establish a hardship waiver for part or all

of any premium authorized under this section . A parent or caretaker may apply to the commissioner for a hardship waiver in a manner

and form established by the commissioner. If the parent or caretaker can demonstrate to the satisfaction of the commissioner,

pursuant to regulations adopted by the commissioner, that payment of all or part of

the premium for the parent or caretaker's child presents a hardship, the commissioner

shall grant the waiver for a prescribed period of time.