Establishes limited medical benefit program for individuals losing NJ FamilyCare coverage under "One Big Beautiful Bill Act"; establishes medical relief fund in Treasury; appropriates funds.

A2251

ASSEMBLY, No. 2251

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

Co-Sponsored by:

Assemblyman Danielsen

SYNOPSIS

���� Establishes limited medical benefit program for
individuals losing NJ FamilyCare coverage under "One Big Beautiful Bill
Act"; establishes medical relief fund in Treasury; appropriates funds.

CURRENT VERSION OF TEXT

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

��

An Act

concerning medical relief for certain
individuals, supplementing Title 30 of the Revised Statutes, and making an
appropriation.

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

���� 1.��� As used in this act:

���� �Department� means the
Department of Human Services.

���� �Electronic benefits transfer
card� means the payment card used or intended for use to access medical relief
benefits under the electronic benefit distribution system established pursuant
to section 5 of P.L.1997, c.37 (C.44:10-75), on which medical relief funds
shall be deposited, and through which recipients can pay for qualifying medical
services provided pursuant to this act.

���� �Eligibility
redetermination" means the administrative process by which the Division of
Medical Assistance and Health Services in the Department of Human Services or a
county social services agency reviews an enrollee�s income, financial
resources, and circumstances relating to the beneficiary's application for
continuation of benefits received under Medicaid or NJ FamilyCare.

���� �Eligible individuals� means
NJ FamilyCare enrollees who are disenrolled due to the following provisions of
the federal �One Big Beautiful Bill Act (OBBBA),� Pub.L. 119-21:

���� a.���� section 71107,
concerning frequency of eligibility redeterminations for continued enrollment
in Medicaid and the Children�s Health Insurance Program;

���� b.��� section 71109,
concerning immigrant eligibility for Medicaid and the Children�s Health Insurance
Program benefits; or

���� c.���� section 71119,
concerning Medicaid community engagement requirements for certain enrollees.

���� �Medicaid� means the program
established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

���� �NJ FamilyCare� means the
Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.)
and the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.)
which includes the Children�s Health Insurance Program (CHIP).

���� �Participating medical relief
services provider� means a State licensed advanced practice nurse, clinical
social worker, professional counselor, physician, physician assistant,
psychiatrist, psychologist, or social worker, acute care hospital, or pharmacy
that has registered with the Department of Human Services to provide qualifying
medical services to eligible individuals under the State�s medical relief
program.

���� �Qualifying medical services�
means the following outpatient medical care and services, when purchased by an
eligible individual with medical relief funds made available on an electronic
benefits transfer card issued to the eligible individual: hospital emergency
room, physician, prescription drugs, and behavioral health services.

���� 2.��� a.� Notwithstanding the
provisions of any law or regulation to the contrary, and conditioned upon the
State�s continued eligibility for federal financial participation for State
expenditures under the federal Medicaid and Children�s Health Insurance Programs,
the Commissioner of Human Services shall establish a State medical relief
program to provide funding that eligible individuals may use to purchase
qualifying medical services from a participating medical relief services
provider, following the eligible individual�s disenrollment from the NJ
FamilyCare program due to the federal �One Big Beautiful Bill Act,� Pub.L.
119-21.�

���� b.��� On an annual basis, and
subject to the availability of funding pursuant to section 9 of this act, the
commissioner shall determine the amount of medical relief benefits to be
provided, in an equal allotment across the pool of eligible individuals, to an eligible
individual.

���� c.���� (1)� The commissioner
shall provide the amount of an eligible individual�s medical relief benefits for
a 12-month period on an electronic benefits transfer card at the time that the
individual is first determined eligible for benefits, and upon subsequent
determination, made by the Department of Human Services pursuant to subsection
c. of section 4 of this act, that the individual remains eligible for benefits
under the State medical relief program.�

���� (2)�� The department shall
review and determine an eligible individual�s continued eligibility for medical
relief benefits no later than 12 months from the date of the previous
determination, timed to coincide with an eligible individual�s NJ FamilyCare
eligibility redetermination, if applicable.

���� (3)�� (a) Medical relief
benefits shall be available for expenditure on qualifying medical services for
a 12-month period, beginning on the day on which the benefits are issued to the
eligible individual, or until such time as the benefits have been expended, whichever
is earlier.�

���� (b)�� If an eligible
individual expends the full amount of the individual�s medical relief benefits
before the end of the 12-month period following the issue date, no additional
medical relief benefits shall be made available to the eligible individual
until the date on which the department determines that the individual remains
eligible for medical relief benefits for another 12-month period.

���� (c)�� An eligible individual,
who expends the full amount of the individual�s allocated medical relief
benefits, may purchase qualifying medical services from a participating medical
relief services provider at a rate that is equal to the NJ FamilyCare reimbursement
rate for the identical service, as provided pursuant to subsection b. of
section 5 of this act.

���� d.��� Any medical relief
benefits, provided pursuant to subsection a. of this section, which remain
unexpended at the conclusion of an eligible individual�s 12-month period
,
shall
be returned to the department for deposit into the General Fund.�

���� e.���� The commissioner shall
establish an online portal and a process by which an eligible individual may
view claims for qualifying medical services that have been paid from the
eligible individual�s medical relief benefits pursuant to this section, and any
remaining medical relief benefits.

���� f.���� The medical relief
benefits provided pursuant to subsection a. of this section shall not
constitute comprehensive health insurance for the purposes of determining an
eligible individual�s eligibility for medical services, provided on a sliding
fee scale based on income and health insurance status, at a federally qualified
health center.

���� g.��� Under no circumstances
shall an eligible individual be required to participate in the State medical
relief program established pursuant to subsection a. of this section.

���� 3.��� a.� Upon notification
that an individual has been disenrolled from the NJ FamilyCare program due to
the federal �One Big Beautiful Bill Act,� Pub.L. 119-21, the Commissioner of
Human Services shall enroll the eligible individual in the State medical relief
program on a provisional basis, which enrollment shall entitle the eligible
individual to medical relief benefits provided pursuant to subsection a. of
section 2 of this act, until the earlier of:

���� (1)�� the date on which the
Department of Human Services approves the individual�s application for medical
relief benefits pursuant to subsection a. of section 2 of this act, at which
time the individual�s eligibility will convert from provisional to full status;

���� (2)�� six months from the date
on which the individual received notice from the department concerning the
individual�s disenrollment from the NJ FamilyCare program due to the provisions
of the federal �One Big Beautiful Bill Act,� Pub.L. 119-21,� unless the
individual has a pending application for the State medical relief program;

���� (3)�� a determination by the
department that the individual does not qualify for medical relief benefits
according to the requirements established pursuant to subsection a. of section
2 of this act; or

���� (4)�� the individual notifies
the department, on a form and according to a process established by the
commissioner, that the individual does not wish to receive provisional medical
relief benefits pursuant to this subsection.

���� b.��� An individual
provisionally enrolled in the State medical relief program shall be entitled to
all of the medical relief benefits provided pursuant to section 2 of this act.

���� c.���� At the time that the
department approves an application for medical relief benefits submitted by a
provisional medical relief recipient, the department shall convert the
provisional medical relief benefits, allocated to the provisional medical
relief participant�s electronic benefits transfer card, to full medical relief
benefits status.

���� 4.��� a.� An eligible individual
who has been disenrolled from the NJ FamilyCare program due to the provisions
of the federal �One Big Beautiful Bill Act,� Pub.L. 119-21, may apply for
medical relief benefits according to a process to be established by the
Commissioner of Human Services.

���� b.��� The commissioner shall
publish information on the State medical relief program and the process by
which an eligible individual may apply for medical relief benefits on the
Department of Human Services� website.� Print copies of this information shall
also be made available in public locations, including, but not limited to:

���� (1)�� county social services agencies;

���� (2)�� any agency or office
distributing food pursuant to the special supplemental food program for women,
infants and children (WIC), established pursuant to P.L.1987, c.261
(C.26:1A-36.1 et seq.) and Pub.L. 95-267 (42 U.S.C. s.1786);

���� (3)�� acute care hospitals;
and

���� (4)�� federally qualified
health centers.

���� c.���� (1) The department
shall redetermine an eligible individual�s continued eligibility for medical
relief benefits no later than every 12 months from the date of the previous
determination, timed to coincide with an eligible individual�s NJ FamilyCare
eligibility determination, if applicable.�

���� (2)�� An eligible individual�s
continued eligibility for medical relief benefits, beyond the initial 12-month
eligibility period, shall be determined according to criteria that shall be
developed by the commissioner.� These criteria shall include, but shall not be
limited to, the eligible individual�s income, financial resources, and State
residency.�

���� (3)�� An eligible individual
who receives medical relief benefits pursuant to subsection a. of section 2 of
this act shall be required to reapply for the NJ FamilyCare program at each
opportunity to do so, unless the eligible individual has been disenrolled from
the NJ FamilyCare program due to the requirements of section 71109 of the
federal �One Big Beautiful Bill Act,� Pub.L. 119-21.

���� (4)�� If, at the time of an
eligible individual�s NJ FamilyCare redetermination, the department finds that
the individual qualifies for the NJ FamilyCare program, the individual�s
medical relief benefits shall be terminated according to a process established
by the Commissioner of Human Services.

���� d.��� Under no circumstances
shall an eligible individual be simultaneously enrolled in, and receive
benefits under, both the State medical relief program and the NJ FamilyCare
program.

���� 5.��� a.� The Commissioner of
Human Services shall establish a process by which a licensed health care
provider may register with the Department of Human Services to become a participating
medical relief services provider under the medical relief program established
pursuant to this act.� At a minimum, information regarding the application
process shall be made available on the department�s website and on the website
of the State�s Medicaid fiscal agent.

���� b.��� Participating medical
relief services providers shall agree to:

���� (1)�� accept medical relief
benefits, accessed via an eligible individual�s electronic benefits transfer
card pursuant to subsection c. of section 2 of this act, as payment for the
provision of qualified medical services;

���� (2)�� charge an eligible
individual for qualified medical services at the same rate charged to the NJ
FamilyCare program for the identical service; and

���� (3)�� continue to provide
qualified medical services, billed at the same rate charged to the NJ
FamilyCare program for the identical service, for an eligible individual who
has expended their medical relief benefits and chooses to self-pay for
qualifying medical services.

���� 6.��� a.� The Commissioner of
Human Services shall establish a process by which the Department of Human
Services shall verify claims for qualifying medical relief services purchased
by an eligible individual using medical relief funds.�

���� b.��� At a frequency and
according to a process to be determined by the commissioner, the department
shall audit medical relief program expenditures in order to ensure the
program�s financial integrity.

���� c.���� The commissioner shall
establish a process to identify and refund to the State medical relief program
any claims, originally paid using State medical relief program funds, that are
reimbursable under the NJ FamilyCare program.

���� 7.��� a.� There is established
in the Department of the Treasury a nonlapsing revolving fund to be known as
the New Jersey Medical Relief Fund, which shall be the repository for:� (1)
funds annually appropriated by the Legislature for the State medical relief program;
and (2) the annual amount of State funds that the State otherwise would expend
to provide NJ FamilyCare coverage for eligible enrollees of the medical relief
program absent the federal �One Big Beautiful Bill Act,� Pub.L. 119-21.�

���� b.��� The State Treasurer
shall be the custodian of the New Jersey Medical Relief Fund, and all
disbursements from the fund shall be made by the State Treasurer upon
certification by the Commissioner of Human Services or the commissioner�s
designee.� The monies in the fund shall be invested and reinvested by the
Director of the Division of Investment in the Department of the Treasury in the
same manner as other trust funds in the custody of the State Treasurer, in the
manner provided by law.� Interest received on the monies in the fund shall be
credited to the fund.

���� c.���� The State Treasurer, in
consultation with the Commissioner of Human Services, shall authorize the
transfer of New Jersey Medical Relief Fund resources to the Department of Human
Services to provide medical relief benefits via the electronic benefits transaction
card issued to an eligible individual pursuant to subsection c. of section 2 of
this act.

���� 8.��� The State Treasurer and
the Commissioner of Human Services shall, in accordance with the
"Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.),
adopt rules and regulations as necessary to implement this act and to ensure
that medical relief benefits are not used to supplant other forms of benefits
maintained by eligible individuals.

���� 9.��� There is appropriated
from the General Fund to the New Jersey Medical Relief Fund the sum of
$650,000,000, in addition to the amount of State funds that the State otherwise
would expend to provide NJ FamilyCare benefits to eligible enrollees of the
medical relief program absent the federal �One Big Beautiful Bill Act,� Pub.L.
119-21.��

���� 10.� This act shall take
effect on October 1, 2026, except the State Treasurer and the Commissioner of
Human Services may take such anticipatory action in advance thereof as shall be
necessary to implement the provisions of this act.

STATEMENT

���� This bill establishes the
State medical relief program (the program) in the Department of Human Services
(the department) to provide certain NJ FamilyCare enrollees, disenrolled from
NJ FamilyCare benefits because of new eligibility suppressing conditions in the
federal �One Big Beautiful Bill Act (OBBBA),� with limited medical relief funds
for qualifying medical services.� �Qualifying medical services� are the
following outpatient services: hospital emergency room, physician, and
behavioral health services, and prescription drugs.� Individuals eligible for
the program are those who lose NJ FamilyCare benefits due to certain OBBBA
provisions: community engagement (work) requirements, more frequent eligibility
redeterminations, and discontinuation of Medicaid and Children�s Health
Insurance Program (CHIP) eligibility for certain �qualified immigrants.�

�

���� Medical relief benefits will
be provided, in equal allotments to all eligible individuals, via an electronic
benefits transfer (EBT) card, with which an eligible individual may purchase qualifying
medical services from licensed medical providers who have registered with the
department to participate in the program.� The amount of an eligible
individual�s medical relief benefit for a 12-month period, subject to the
availability of State funding, will be determined annually by the Commissioner
of Human Services (the commissioner) and deposited on the individual�s EBT card
at the time of initial application approval, and at subsequent annual
eligibility redeterminations.� An eligible individual must reapply for the NJ
FamilyCare program at each opportunity to do so, unless the eligible individual
has been disenrolled from NJ FamilyCare due to the immigrant provisions of
OBBBA.
�

���� Medical relief benefits will
remain available for 12 months, or until fully expended.� Once an individual
has exhausted the individual�s medical relief benefits for a 12-month period,
the individual may choose to self-pay for qualifying medical services from a
participating provider, at a cost that equals the NJ FamilyCare rate for the
identical service.�

���� The commissioner will
automatically enroll individuals who lose NJ FamilyCare benefits under OBBBA in
the program on a provisional basis, unless the individual affirmatively opts
out.� Provisionally enrolled individuals will receive full medical relief
benefits until: (1) the department approves the individual�s application for
the program; (2) six months from the date that the individual was disenrolled
from NJ FamilyCare; (3) the department determines that the individual does not
qualify for medical relief benefits; or (4) the individual notifies the
department that the individual wishes to opt out of the program.�

���� Participating medical relief
service providers must agree to accept medical relief benefits as payment for qualified
medical services and to charge the NJ FamilyCare rate for qualified medical
services provided under the program.

���� The bill establishes the New
Jersey Medical Relief Fund (the fund) in the Department of the Treasury as a
nonlapsing revolving fund, which will be the repository for Legislative
appropriations for the program, plus the amount of State funding, as determined
by the commissioner, that the State otherwise would have expended to provide NJ
FamilyCare benefits for program participants.

���� This bill appropriates $650
million to the fund, as well as the unexpended State funds resulting from NJ
FamilyCare enrollees shifting to the program.� The bill�s provisions will take
effect on October 1, 2026, but the State Treasurer and the commissioner may take
actions prior to this date to implement the bill�s requirements.