Establishes pilot program providing NJ FamilyCare eligibility for children with special needs who would otherwise be ineligible due to parental income and assets, and requires DHS commissioner to conduct study.

A1631

ASSEMBLY, No. 1631

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman SEAN T. KEAN

District 30 (Monmouth and Ocean)

SYNOPSIS

���� Establishes pilot program providing NJ FamilyCare
eligibility for children with special needs who would otherwise be ineligible
due to parental income and assets, and requires DHS commissioner to conduct
study.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning NJ FamilyCare eligibility for certain
children.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� As used in this act:

���� �Child with special needs�
means a child under the age of 21 years who is blind or disabled, as defined in
section 1614(a)(3)(C) of Title XVI of the federal �Social Security Act,� (42
U.S.C. 1382c).

���� NJ FamilyCare� means the
program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which
includes the Medicaid program and the Children�s Health Insurance Program.

���� 2.��� a.� The Commissioner of
Human Services shall establish a three year pilot program to provide NJ Family
Care benefits for a child with special needs who lives in the family home and,
except for parental income or resources, would otherwise qualify for benefits
under the federal Supplemental Security Income program, established pursuant to
Title XVI of the federal �Social Security Act,� (42 U.S.C. 1381 et seq.).

���� b.��� (1)� On an annual basis,
the Department of Human Services shall redetermine whether a child with special
needs continues to meet the definition of blind or disabled for the purposes of
the federal Supplemental Security Income program, as provided in section
1614(a)(3)(C) of Title XVI of the federal �Social Security Act,� (42 U.S.C.
1382c).

���� (2)�� If, as a result of the
redetermination process provided in paragraph (1) of this subsection, the
department determines that the child no longer qualifies as blind or disabled
for the purposes of the federal Supplemental Security Income program, the department
shall terminate NJ FamilyCare benefits for the child.

���� (3)�� The commissioner shall
establish a process by which the parent or legal guardian of a child with
special needs can appeal the termination of NJ FamilyCare benefits resulting
from a redetermination conducted pursuant to paragraph (1) of this subsection.

���� 3.��� Within 180 days of the
conclusion of the pilot program established pursuant to section 2 of this act,
the Commissioner of Human Services shall report to the Governor, and to the
Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the number
of children with special needs who became newly eligible for NJ FamilyCare
benefits pursuant to section 2 of this act, the total cost of the NJ FamilyCare
benefits provided to these children, and the department�s costs to administer
the pilot program.� The report shall also include the commissioner�s
recommendations on whether the State should make the NJ FamilyCare benefits,
available under the pilot program, permanent for children with special needs.

���� 4.��� The Commissioner of
Human Services shall apply for such State plan amendments or waivers as may be
necessary to implement the provisions of this act and to secure federal
financial participation for State Medicaid expenditures under the federal
Medicaid program.

���� 5.��� The Commissioner of
Human Services shall adopt rules and regulations pursuant to the
"Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.)
to implement the provisions of this act.

���� 6.��� This act shall take
effect immediately and shall expire upon the submission of the report pursuant
to section 3 of this act.

STATEMENT

���� The bill requires the
Commissioner of Human Services (the commissioner) to establish a three year
pilot program to provide NJ FamilyCare benefits to children with special needs
who live in the family home and, except for parental income and assets, would
qualify for federal Supplemental Security Income (SSI) benefits.� The bill
defines a �child with special needs� as a child under the age of 21 who meets
the federal definition of blind or disabled for the purposes of the SSI
program, as provided in section 1614(a)(3)(C) of Title XVI of the federal
�Social Security Act,� (42 U.S.C. 1382c).

���� The Department of Human
Services (department) will annually redetermine whether a child with special
needs continues to meet the definition of blind or disabled under the SSI
program.� If the department determines that the child no longer qualifies as blind
or disabled for the purposes of the SSI program, the department will terminate
the child�s NJ FamilyCare benefits.� The commissioner will establish an appeals
process for families whose child�s NJ FamilyCare benefits were terminated
subsequent to a redetermination.

���� Within 180 days of the end of
the pilot program, the commissioner will report to the Governor and to the
Legislature on:

���� 1.��� the number of children
with special needs who became eligible for NJ FamilyCare benefits under the
initiative;

���� 2.��� State costs to provide
NJ FamilyCare benefits under the pilot program;

���� 3.��� the department�s costs
to administer the pilot program; and

���� 4.��� the commissioner�s
recommendations concerning continuation of the benefits available under the
initiative.�

���� The pilot program will expire
upon submission of the report to the Governor and the Legislature.�

���� Federal SSI benefits, which
include monthly income support and access to State Medicaid benefits, are
available to children under the age of 18, or children under the age of 22 who
are students regularly attending school, and who meet the SSI program�s definition
of blind or disabled.� Federal SSI benefits are only available to special needs
children whose parents or legal guardian have limited income and assets.�

���� Under the State�s
comprehensive Medicaid demonstration waiver, children whose medical condition
necessitates a nursing home level of care can access private duty nursing
services through the Medicaid Long-Term Supports and Services program (MLTSS),
regardless of parental income or assets.� Many middle-income families of
children whose disabilities do not require nursing-home level of care, and who
do not qualify for NJ FamilyCare or SSI benefits due to income or assets,
struggle to afford the care and services necessary for their children to
continue to live in the family home.� It is the sponsor�s intent to provide,
even on a pilot basis, NJ FamilyCare benefits to alleviate the financial burden
placed on middle-income families who have children with special needs.