Codifies and requires Legislative authorization for reductions in minimum NJ FamilyCare eligibility levels and benefits.

A2253

ASSEMBLY, No. 2253

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

SYNOPSIS

���� Codifies and requires Legislative authorization for
reductions in minimum NJ FamilyCare eligibility levels and benefits.

CURRENT VERSION OF TEXT

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

��

An Act

concerning NJ FamilyCare, amending P.L.2005,
c.156 and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).

����
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 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.

����
m.�� Notwithstanding the
provision of any law, rule, or regulation to the contrary, and conditioned upon
the continued receipt of federal financial participation for State expenditures
under the federal Medicaid program and the Children�s Health Insurance Program:

����
(1)�� the NJ FamilyCare
program income and asset eligibility standards and benefits in place on�
January 19, 2025 shall not be reduced or eliminated, except upon the enactment
of legislation by the State Legislature; and

����
(2) the definition of a
�qualified applicant� pursuant to section 4 of P.L.2005, c.156 (C.30:4J-11), in
place on January 19, 2025, shall not be changed, except upon the enactment of
legislation by the State Legislature
.

(cf: P.L.2021, c.132, s.1)

���� 2.��� (New section)� Notwithstanding
the provision of any law, rule, or regulation to the contrary, and conditioned
upon the continued receipt of federal financial participation for State
expenditures under the federal Medicaid program:

���� a.���� the Medicaid program income
and asset eligibility standards and benefits in place on January 19, 2025 shall
not be reduced or eliminated, except upon the enactment of legislation by the
State Legislature; and

���� b.��� the categories of qualified
applicants eligible for benefits under the State Medicaid program on January
19, 2025 shall not be changed, except upon the enactment of legislation by the
State Legislature.

���� 3.��� (New section)� 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.

���� 4.��� This act shall take
effect immediately.

STATEMENT

���� The bill codifies the NJ
FamilyCare income and asset eligibility standards, categories of individuals
eligible for benefits, and the benefits available under the program at the
levels in place as of January 19, 2025, and specifies that these standards and
benefits may not be reduced or eliminated except upon enactment of legislation
by the State Legislature.� The bill conditions these requirements upon the
continued receipt of federal financial participation for State expenditures under
the federal Medicaid program.� The NJ FamilyCare program encompasses the State
Medicaid program and the Children�s Health Insurance Program.