Expands availability of NJ FamilyCare Advantage program.

A2070

ASSEMBLY, No. 2070

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman LINDA S. CARTER

District 22 (Somerset and Union)

SYNOPSIS

���� Expands availability of NJ FamilyCare Advantage
program.

CURRENT VERSION OF TEXT

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

��

An Act
expanding the NJ FamilyCare Advantage program, and
amending and supplementing P.L.2005, c.156.

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

���� 1.��� Section 5 of P.L.2005,
c.156 (C.30:4J-12) is amended to read as follows:

���� 5.��� 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 shall require
families to pay copayments and make premium contributions, based upon a sliding
income scale.� 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,
including, but not limited to, restrictions on voluntary disenrollments from
existing health insurance coverage;

���� (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,
premium payments and copayments, and 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; and

���� (6)�� Provision of program
eligibility-identification cards that are issued no more frequently than once a
year.

���� �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.��� Subject to federal
approval, a child shall be determined ineligible for the program if the child
was voluntarily disenrolled from employer-sponsored group insurance coverage
within six months prior to application to the program.

���� �g.�� The commissioner shall
provide, by regulation, for presumptive eligibility for the program in
accordance with the following provisions:

���� (1)�� A child who presents
himself 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% 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% of the
poverty level, up to a maximum of 350% of the poverty level, shall be
disregarded.

���� �j.��� The commissioner shall
establish a NJ FamilyCare coverage buy-in program through which a parent
,

[
or
]
caretaker
,
or individual
whose
individual or
family income exceeds
[
350% of the
poverty level
]

the income level for eligibility for the NJ FamilyCare program or for
Medicaid
may purchase coverage under NJ FamilyCare
[
for a child
under the age of 19, who is uninsured and was not voluntarily disenrolled from
employer-sponsored group insurance coverage within six months prior to
application to the program
]

as provided pursuant to section 2 of P.L.�� , c.��� (C.������� ) (pending
before the Legislature as this bill)
.� The program 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
]

an
individual of
comparable age whose
individual or
family income is
between 200% and 350% 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
, NJ FamilyCare Advantage,

and Medicaid programs.

���� l.���� Subject to federal
approval, the Commissioner of Human Services shall establish a hardship waiver
for part or all of the premium for an eligible child under the NJ FamilyCare
program.� 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.

(cf: P.L.2008, c.53, s.2)

���� 2.��� (New section)� a.� The
Department of Human Services shall establish the NJ FamilyCare Advantage
program as follows. The NJ FamilyCare Advantage program shall make available
for purchase the NJ FamilyCare Advantage health care plan for all qualified
residents of New Jersey.

���� b.��� The Commissioner of
Human Services shall integrate eligibility screening for NJ FamilyCare and the
Medicaid program into the application process for the NJ FamilyCare Advantage health
care plan, and establish a system that allows for transition of enrollment
between the Medicaid or the NJ FamilyCare program and the NJ FamilyCare
Advantage health care plan for individuals whose eligibility has been affected
by a change in income.

���� c.���� The NJ FamilyCare
Advantage health care plan shall provide coverage that is at least as
comprehensive as the coverage defined in 42 U.S.C. 18022(b) and that offers
benefits that equal or exceed those that are available by the plan approved by
the Centers for Medicare and Medicaid Services as the State qualified essential
health benefits plan.

���� d.��� Enrollees in the NJ
FamilyCare Advantage health care plan who are applicable taxpayers may receive
a refundable credit for such coverage pursuant to provisions of the federal
Internal Revenue Code, 26 U.S.C. 36B.�

���� e.���� The Commissioner of
Human Services shall coordinate with the Department of the Treasury and the
federal Department of Health and Human Services to the extent necessary to
incorporate eligibility for a refundable credit pursuant to subsection. of this
section for the NJ FamilyCare Advantage health care plan into the NJ FamilyCare
Advantage health care plan application and plan enrollment.

���� f.���� 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.

���� g.��� The Commissioner of
Human Services shall apply for any federal waivers or other federal approval
required to implement this section. The commissioner shall also apply for any
applicable grant or demonstration project under the Patient Protection and Affordable
Care Act, Pub. L. 111-148, or the Health Care and Education Reconciliation Act
of 2010, Pub. L. 111-152, that would further the purposes of or assist in the
establishment of the NJ FamilyCare Advantage health care plan.

���� h.��� Pursuant to this
section, �qualified resident� means an individual who resides in the geographic
boundaries of the State of New Jersey who is not financially or medically
eligible for the State Medicaid program or the NJ FamilyCare program.�

���� 3.��� The Commissioner of
Human Services, pursuant to the �Administrative Procedure Act,� P.L.1968, c.410
(C.52:14B-1 et seq.), shall adopt rules and regulations as the
commissioner determines necessary to effectuate the purposes of this act.

���� 4.��� This act shall take
effect on the first day of the 12
th
month next following the date of
the enactment, except the Commissioner of Human Services may take any
anticipatory action in advance as shall be necessary for the implementation of
this act.�

STATEMENT

���� This bill would expand the
availability of the NJ FamilyCare Advantage program. The program provides an
opportunity for individuals to purchase health care coverage through the
Medicaid program. This coverage would be known as the NJ FamilyCare Advantage
health care plan and would be available for purchase to all individuals in the
State, who are not eligible for Medicaid or NJ FamilyCare.

���� The bill requires that the NJ
FamilyCare Advantage health care plan would need to meet the specifications of
a plan which provides the essential health benefits as defined in the
Affordable Care Act. The health care plan could then be purchased through the
Federal Health Care Exchange. This would allow qualified individuals to access
tax credits available when purchasing the NJ FamilyCare Advantage health care
plan through the Exchange.