Provides comprehensive Medicaid benefits to certain individuals formerly in foster care.

S2800

SENATE, No. 2800

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Senator ANGELA V. MCKNIGHT

District 31 (Hudson)

SYNOPSIS

���� Provides comprehensive Medicaid benefits to certain
individuals formerly in foster care.

CURRENT VERSION OF TEXT

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

��

An Act
concerning Medicaid benefits for certain youth and
amending P.L.1968, c.413.

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

����� 1.�� Section
3 of P.L.1968, c.413 (C.30:4D-3) is amended to read as follows:

����� 3.�� Definitions.
As used in P.L.1968, c.413 (C.30:4D-1 et seq.), and unless the context
otherwise requires:

����� a.�� "Applicant"
means any person who has made application for purposes of becoming a
"qualified applicant."

����� b.�� "Commissioner"
means the Commissioner of Human Services.

����� c.�� "Department"
means the Department of Human Services, which is herein designated as the
single State agency to administer the provisions of this act.

����� d.�� "Director"
means the Director of the Division of Medical Assistance and Health Services.

����� e.�� "Division"
means the Division of Medical Assistance and Health Services.

����� f.��� "Medicaid"
means the New Jersey Medical Assistance and Health Services Program.

����� g.�� "Medical
assistance" means payments on behalf of recipients to providers for
medical care and services authorized under P.L.1968, c.413.

����� h.�� "Provider"
means any person, public or private institution, agency, or business concern
approved by the division lawfully providing medical care, services, goods, and
supplies authorized under P.L.1968, c.413, holding, where applicable, a current
valid license to provide such services or to dispense such goods or supplies.

����� i.��� "Qualified
applicant" means a person who is a resident of this State, and either a
citizen of the United States or an eligible alien, and is determined to need
medical care and services as provided under P.L.1968, c.413, with respect to
whom the period for which eligibility to be a recipient is determined shall be
the maximum period permitted under federal law, and who:

����� (1)� Is
a dependent child or parent or caretaker relative of a dependent child who
would be, except for resources, eligible for the aid to families with dependent
children program under the State Plan for Title IV-A of the federal Social
Security Act as of July 16, 1996;

����� (2)� Is
a recipient of Supplemental Security Income for the Aged, Blind and Disabled
under Title XVI of the Social Security Act;

����� (3)� Is
an "ineligible spouse" of a recipient of Supplemental Security Income
for the Aged, Blind and Disabled under Title XVI of the Social Security Act, as
defined by the federal Social Security Administration;

����� (4)� Would
be eligible to receive Supplemental Security Income under Title XVI of the
federal Social Security Act or, without regard to resources, would be eligible
for the aid to families with dependent children program under the State Plan
for Title IV-A of the federal Social Security Act as of July 16, 1996, except
for failure to meet an eligibility condition or requirement imposed under such
State program which is prohibited under Title XIX of the federal Social
Security Act such as a durational residency requirement, relative
responsibility, consent to imposition of a lien;

����� (5)� (Deleted
by amendment, P.L.2000, c.71).

����� (6)� Is
an individual under 21 years of age who, without regard to resources, would be,
except for dependent child requirements, eligible for the aid to families with
dependent children program under the State Plan for Title IV-A of the federal
Social Security Act as of July 16, 1996, or groups of such individuals,
including but not limited to, children in resource family placement under
supervision of the Division of Child Protection and Permanency in the
Department of Children and Families whose maintenance is being paid in whole or
in part from public funds, children placed in a resource family home or
institution by a private adoption agency in New Jersey or children in
intermediate care facilities, including developmental centers for the
developmentally disabled, or in psychiatric hospitals;

����� (7)� Would
be eligible for the Supplemental Security Income program, but is not receiving
such assistance and applies for medical assistance only;

����� (8)� Is
determined to be medically needy and meets all the eligibility requirements
described below:

����� (a)� The
following individuals are eligible for services, if they are determined to be
medically needy:

����� (i)�� Pregnant
women;

����� (ii)�� Dependent
children under the age of 21;

����� (iii)� Individuals
who are 65 years of age and older; and

����� (iv) Individuals
who are blind or disabled pursuant to either 42 C.F.R.435.530 et seq. or 42
C.F.R.435.540 et seq., respectively.

����� (b)� The
following income standard shall be used to determine medically needy
eligibility:

����� (i)�� For
one person and two person households, the income standard shall be the maximum
allowable under federal law, but shall not exceed 133 1/3% of the State's
payment level to two person households under the aid to families with dependent
children program under the State Plan for Title IV-A of the federal Social
Security Act in effect as of July 16, 1996; and

����� (ii)� For
households of three or more persons, the income standard shall be set at 133
1/3% of the State's payment level to similar size households under the aid to
families with dependent children program under the State Plan for Title IV-A of
the federal Social Security Act in effect as of July 16, 1996.

����� (c)� The
following resource standard shall be used to determine medically needy
eligibility:

����� (i)�� For
one person households, the resource standard shall be 200% of the resource
standard for recipients of Supplemental Security Income pursuant to 42 U.S.C.
s.1382(1)(B);

����� (ii)
�For two person households, the resource standard shall be 200% of the resource
standard for recipients of Supplemental Security Income pursuant to 42 U.S.C.
s.1382(2)(B);

����� (iii)� For
households of three or more persons, the resource standard in subparagraph
(c)(ii) above shall be increased by $100.00 for each additional person; and

����� (iv)� The
resource standards established in (i), (ii), and (iii) are subject to federal
approval and the resource standard may be lower if required by the federal
Department of Health and Human Services.

����� (d) Individuals
whose income exceeds those established in subparagraph (b) of paragraph (8) of
this subsection may become medically needy by incurring medical expenses as
defined in 42 C.F.R.435.831(c) which will reduce their income to the applicable
medically needy income established in subparagraph (b) of paragraph (8) of this
subsection.

����� (e)� A
six-month period shall be used to determine whether an individual is medically
needy.

����� (f)� Eligibility
determinations for the medically needy program shall be administered as
follows:

����� (i)�� County
welfare agencies and other entities designated by the commissioner are
responsible for determining and certifying the eligibility of pregnant women
and dependent children.� The division shall reimburse county welfare agencies
for 100% of the reasonable costs of administration which are not reimbursed by
the federal government for the first 12 months of this program's operation.
Thereafter, 75% of the administrative costs incurred by county welfare agencies
which are not reimbursed by the federal government shall be reimbursed by the
division;

����� (ii)� The
division is responsible for certifying the eligibility of individuals who are
65 years of age and older and individuals who are blind or disabled.� The
division may enter into contracts with county welfare agencies to determine
certain aspects of eligibility. In such instances the division shall provide
county welfare agencies with all information the division may have available on
the individual.

����� The
division shall notify all eligible recipients of the Pharmaceutical Assistance
to the Aged and Disabled program, P.L.1975, c.194 (C.30:4D-20 et seq.) on an
annual basis of the medically needy program and the program's general
requirements.� The division shall take all reasonable administrative actions to
ensure that Pharmaceutical Assistance to the Aged and Disabled recipients, who
notify the division that they may be eligible for the program, have their
applications processed expeditiously, at times and locations convenient to the
recipients; and

����� (iii)
�The division is responsible for certifying incurred medical expenses for all
eligible persons who attempt to qualify for the program pursuant to
subparagraph (d) of paragraph (8) of this subsection;

����� (9)���� (a)
�Is a child who is at least one year of age and under 19 years of age and, if
older than six years of age but under 19 years of age, is uninsured; and

����� (b)� Is
a member of a family whose income does not exceed 133% of the poverty level and
who meets the federal Medicaid eligibility requirements set forth in section
9401 of Pub.L.99-509 (42 U.S.C. s.1396a);

����� (10)��� Is
a pregnant woman who is determined by a provider to be presumptively eligible
for medical assistance based on criteria established by the commissioner,
pursuant to section 9407 of Pub.L.99-509 (42 U.S.C. s.1396a(a));

����� (11)
Is an individual 65 years of age and older, or an individual who is blind or
disabled pursuant to section 301 of Pub.L.92-603 (42 U.S.C. s.1382c), whose
income does not exceed 100% of the poverty level, adjusted for family size, and
whose resources do not exceed 100% of the resource standard used to determine
medically needy eligibility pursuant to paragraph (8) of this subsection;

����� (12)
Is a qualified disabled and working individual pursuant to section 6408 of
Pub.L.101-239 (42 U.S.C. s.1396d) whose income does not exceed 200% of the
poverty level and whose resources do not exceed 200% of the resource standard
used to determine eligibility under the Supplemental Security Income Program,
P.L.1973, c.256 (C.44:7-85 et seq.);

����� (13)
Is a pregnant woman or is a child who is under one year of age and is a member
of a family whose income does not exceed 185% of the poverty level and who
meets the federal Medicaid eligibility requirements set forth in section 9401
of Pub.L.99-509 (42 U.S.C. s.1396a), except that a pregnant woman who is
determined to be a qualified applicant shall, notwithstanding any change in the
income of the family of which she is a member, continue to be deemed a
qualified applicant until the end of the 60-day period beginning on the last
day of her pregnancy;

����� (14)�� (Deleted
by amendment, P.L.1997, c.272).

����� (15)�� (a)� Is
a specified low-income Medicare beneficiary pursuant to 42 U.S.C.
s.1396a(a)10(E)iii whose resources beginning January 1, 1993 do not exceed 200%
of the resource standard used to determine eligibility under the Supplemental
Security Income program, P.L.1973, c.256 (C.44:7-85 et seq.) and whose income
beginning January 1, 1993 does not exceed 110% of the poverty level, and
beginning January 1, 1995 does not exceed 120% of the poverty level.

����� (b)� An
individual who has, within 36 months, or within 60 months in the case of funds
transferred into a trust, of applying to be a qualified applicant for Medicaid
services in a nursing facility or a medical institution, or for home or
community-based services under section 1915(c) of the federal Social Security
Act (42 U.S.C. s.1396n(c)), disposed of resources or income for
less than fair market value shall be ineligible for assistance for nursing
facility services, an equivalent level of services in a medical institution, or
home or community-based services under section 1915(c) of the federal Social
Security Act (42 U.S.C. s.1396n(c)). The period of the ineligibility shall be
the number of months resulting from dividing the uncompensated value of the
transferred resources or income by the average monthly private payment rate for
nursing facility services in the State as determined annually by the
commissioner. In the case of multiple resource or income transfers, the
resulting penalty periods shall be imposed sequentially.� Application of this
requirement shall be governed by 42 U.S.C. s.1396p(c). In accordance with
federal law, this provision is effective for all transfers of resources or
income made on or after August 11, 1993.� Notwithstanding the provisions of
this subsection to the contrary, the State eligibility requirements concerning
resource or income transfers shall not be more restrictive than those enacted
pursuant to 42 U.S.C. s.1396p(c).

����� (c)� An
individual seeking nursing facility services or home or community-based
services and who has a community spouse shall be required to expend those
resources which are not protected for the needs of the community spouse in
accordance with section 1924(c) of the federal Social Security Act (42 U.S.C.
s.1396r-5(c)) on the costs of long-term care, burial arrangements, and any
other expense deemed appropriate and authorized by the commissioner. An
individual shall be ineligible for Medicaid services in a nursing facility or
for home or community-based services under section 1915(c) of the federal
Social Security Act (42 U.S.C. s.1396n(c)) if the individual expends funds in
violation of this subparagraph.� The period of ineligibility shall be the
number of months resulting from dividing the uncompensated value of transferred
resources and income by the average monthly private payment rate for nursing
facility services in the State as determined by the commissioner.� The period
of ineligibility shall begin with the month that the individual would otherwise
be eligible for Medicaid coverage for nursing facility services or home or
community-based services.

����� This
subparagraph shall be operative only if all necessary approvals are received
from the federal government including, but not limited to, approval of
necessary State plan amendments and approval of any waivers;

����� (16)�� Subject
to federal approval under Title XIX of the federal Social Security Act, is a
dependent child, parent or specified caretaker relative of a child who is a
qualified applicant, who would be eligible, without regard to resources, for
the aid to families with dependent children program under the State Plan for
Title IV-A of the federal Social Security Act as of July 16, 1996, except for
the income eligibility requirements of that program, and whose family earned
income,

����� (a)� if
a dependent child, does not exceed 133% of the poverty level; and

����� (b)� if
a parent or specified caretaker relative, beginning September 1, 2005 does not
exceed 100% of the poverty level, beginning September 1, 2006 does not exceed
115% of the poverty level and beginning September 1, 2007 does not exceed 133%
of the poverty level,

plus
such earned income disregards as shall be determined according to a methodology
to be established by regulation of the commissioner;

����� The
commissioner may increase the income eligibility limits for children and
parents and specified caretaker relatives, as funding permits;

����� (17)�� Is
an individual from 18 through 20 years of age who is not a dependent child and
would be eligible for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1
et seq.), without regard to income or resources, who, on the individual's 18th
birthday was in resource family care under the care and custody of the Division
of Child Protection and Permanency in the Department of Children and Families
and whose maintenance was being paid in whole or in part from public funds;

����� (18)�� Is
a person between the ages of 16 and 65 who is permanently disabled and working,
and:

����� (a)� whose
income is at or below 250% of the poverty level, plus other established
disregards;

����� (b)� who
pays the premium contribution and other cost sharing as established by the
commissioner, subject to the limits and conditions of federal law; and

����� (c)� whose
assets, resources and unearned income do not exceed limitations as established
by the commissioner;

����� (19) Is
an uninsured individual under 65 years of age who:

����� (a)� has
been screened for breast or cervical cancer under the federal Centers for
Disease Control and Prevention breast and cervical cancer early detection
program;

����� (b)� requires
treatment for breast or cervical cancer based upon criteria established by the
commissioner;

����� (c)� has
an income that does not exceed the income standard established by the
commissioner pursuant to federal guidelines;

����� (d) meets
all other Medicaid eligibility requirements; and

����� (e)� in
accordance with Pub.L.106-354, is determined by a qualified entity to be
presumptively eligible for medical assistance pursuant to 42 U.S.C.
s.1396a(aa), based upon criteria established by the commissioner pursuant to
section 1920B of the federal Social Security Act (42 U.S.C. s.1396r-1b);

����� (20)�� Subject
to federal approval under Title XIX of the federal Social Security Act, is a
single adult or couple, without dependent children, whose income in 2006 does
not exceed 50% of the poverty level, in 2007 does not exceed 75% of the poverty
level and in 2008 and each year thereafter does not exceed 100% of the poverty
level; except that a person who is a recipient of Work First New Jersey general
public assistance, pursuant to P.L.1947, c.156
(C.44:8-107 et seq.), shall not be a qualified applicant; or

����� (21)�� is
an individual who:

����� (a)� has
an income that does not exceed the highest income eligibility level for
pregnant women established under the State plan under Title XIX or Title XXI of
the federal Social Security Act;

����� (b)� is
not pregnant; and

����� (c)� is
eligible to receive family planning services provided under the Medicaid
program pursuant to subsection k. of section 6 of P.L.1968, c.413 (C.30:4D-6)
and in accordance with 42 U.S.C. s.1396a(ii)
; and

�����
(22)�� Subject
to
federal approval and the availability of federal
financial participation pursuant to an approved State Plan amendment,

waiver of, or demonstration program under, Title XIX of
the federal Social Security Act (42 U.S.C.s.1396 et seq.),
is an
individual who:

�����
(a)� is
between the ages of 18 and 25 years;

�����
(b)� is
not a dependent child;

�����
(c)� was
in resource family care under the care and custody of the authorized child
welfare agency of another state and whose maintenance was paid in whole or in
part from public funds at the time that the individual attained the age at
which said state elects to terminate federal assistance under Title IV-E of the
federal Social Security Act (42 U.S.C.s.670 et seq.); and

�����
(d) was
enrolled in the state plan under Title XIX of another state, or under a waiver or
amendment of such state plan, at the time that the individual attained the age
at which said state elects to terminate federal assistance under Title IV-E of
the federal Social Security Act (42 U.S.C. s.670 et seq.)
.

�����
Individuals
eligible for Title XIX benefits under this subsection shall be eligible without
regard to income or resources.

����� j.��� "Recipient"
means any qualified applicant receiving benefits under this act.

����� k.�� "Resident"
means a person who is living in the State voluntarily with the intention of
making his home here and not for a temporary purpose.� Temporary absences from
the State, with subsequent returns to the State or intent to return when the purposes
of the absences have been accomplished, do not interrupt continuity of
residence.

����� l.��� "State
Medicaid Commission" means the Governor, the Commissioner of Human
Services, the President of the Senate and the Speaker of the General Assembly,
hereby constituted a commission to approve and direct the means and method for
the payment of claims pursuant to P.L.1968, c.413.

����� m.� "Third
party" means any person, institution, corporation, insurance company,
group health plan as defined in section 607(1) of the federal "Employee
Retirement and Income Security Act of 1974," 29 U.S.C. s.1167(1), service
benefit plan, health maintenance organization, or other prepaid health plan, or
public, private or governmental entity who is or may be liable in contract,
tort, or otherwise by law or equity to pay all or part of the medical cost of
injury, disease or disability of an applicant for or recipient of medical
assistance payable under P.L.1968, c.413.

����� n.�� "Governmental
peer grouping system" means a separate class of skilled nursing and
intermediate care facilities administered by the State or county governments,
established for the purpose of screening their reported costs and setting
reimbursement rates under the Medicaid program that are reasonable and adequate
to meet the costs that must be incurred by efficiently and economically
operated State or county skilled nursing and intermediate care facilities.

����� o.�� "Comprehensive
maternity or pediatric care provider" means any person or public or
private health care facility that is a provider and that is approved by the
commissioner to provide comprehensive maternity care or comprehensive pediatric
care as defined in subsection b. (18) and (19) of section 6 of P.L.1968, c.413
(C.30:4D-6).

����� p.�� "Poverty
level" means the official poverty level based on family size established
and adjusted under Section 673(2) of Subtitle B, the "Community Services
Block Grant Act," of Pub.L.97-35 (42 U.S.C. s.9902(2)).

����� q.�� "Eligible
alien" means one of the following:

����� (1)� an
alien present in the United States prior to August 22, 1996, who is:

����� (a)� a
lawful permanent resident;

����� (b)� a
refugee pursuant to section 207 of the federal "Immigration and
Nationality Act" (8 U.S.C. s.1157);

����� (c)� an
asylee pursuant to section 208 of the federal "Immigration and Nationality
Act" (8 U.S.C. s.1158);

����� (d) an
alien who has had deportation withheld pursuant to section 243(h) of the
federal "Immigration and Nationality Act" (8 U.S.C. s.1253 (h));

����� (e)� an
alien who has been granted parole for less than one year by the U.S.
Citizenship and Immigration Services pursuant to section 212(d)(5) of the
federal "Immigration and Nationality Act" (8 U.S.C. s.1182(d)(5));

����� (f)� an
alien granted conditional entry pursuant to section 203(a)(7) of the federal
"Immigration and Nationality Act"
(8 U.S.C. s.1153(a)(7)) in effect prior to April 1, 1980; or

����� (g)� an
alien who is honorably discharged from or on active duty in the United States
armed forces and the alien's spouse and unmarried dependent child.

����� (2)� An
alien who entered the United States on or after August 22, 1996, who is:

����� (a)� an
alien as described in paragraph (1)(b), (c), (d) or (g) of this subsection; or

����� (b)� an
alien as described in paragraph (1)(a), (e) or (f) of this subsection who
entered the United States at least five years ago.

����� (3)� A
legal alien who is a victim of domestic violence in accordance with criteria
specified for eligibility for public benefits as provided in Title V of the
federal "Illegal Immigration Reform and Immigrant Responsibility Act of
1996" (8 U.S.C. s.1641).

(cf:
P.L.2018, c.1, s.1)

���� 2.��� The Commissioner of
Human Services shall apply to the United States Department of Health and Human
Services for such waivers or state plan amendments 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.

���� 3.��� The Commissioner of
Human Services shall, in accordance with the �Administrative Procedures Act,�
P.L.1968, c.410 (C.52:14B-1 et seq.), adopt such rules and regulations as the
commissioner deems necessary to carry out the provisions of this act.

���� 4.��� This act shall take
effect on the first day of the fourth month next following the date of
enactment, except the commissioner may take any anticipatory administrative
action in advance thereof as shall be necessary for the implementation of this
act..

STATEMENT

���� This bill requires the
Commissioner of Human Services to apply to the federal Centers for Medicare and
Medicaid Services (CMS) for Section 1115 demonstration authority to extend New
Jersey FamilyCare coverage to individuals up to age 26 who were in foster care
under the responsibility of another state when the individual attained the age
at which said state has selected for termination of federal foster care
assistance under Title IV-E of the federal Social Security Act (42 U.S.C. s.670
et seq.).� These former foster youth would be eligible for New Jersey
FamilyCare coverage up to age 26, regardless of income or resources.� The bill
brings the State into compliance with federal law, pursuant to the SUPPORT for
Patients and Communities Act, Pub.L.115-271 (42 U.S.C. s.1396a et seq.), albeit
in advance of the federally mandated effective date of calendar year 2023.�

���� The Affordable Care Act (ACA)
allows young adults to maintain health insurance coverage under their parents�
or guardians� health plan until age 26, provided the health plan extends
coverage to dependents.� In order to provide a parallel benefit to former
foster youth who were enrolled in Medicaid at the time that they aged out of
the foster care system, the ACA added these youth as a new, mandatory Medicaid
eligibility group at section 1902(a)(10)(A)(i)(IX) of the federal� Security Act
(42 U.S.C. s.1396 et seq.).�

���� As of January 2019, according
to a Kaiser Family Foundation Survey, eleven states have extended Medicaid
coverage to former foster youth from other states up to age 26 through Medicaid
Section 1115 demonstration waivers.�