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Medicaid, SCHIP, & Federal Authority

  • Section 1115 Waiver – In 2001, the state received approval  from the Centers for Medicare and Medicaid Services (CMS) to implement a waiver demonstration that extended coverage to parents of Medicaid or State Children’s Health Insurance Program (SCHIP)-eligible children with incomes up to 200 percent of the federal poverty level (FPL) and pregnant women with incomes between 185 percent and 200 percent of the FPL. Under this waiver program, Medicaid covered parents with incomes up to 133 percent of the FPL, and SCHIP covered parents with incomes between 134 percent and 200 percent of the FPL. Although parent enrollment was capped as of June 14, 2002, parent enrollment up to 100 percent of the FPL was initiated again on September 1, 2005. This increased to 115 percent of the FPL on September 1, 2006, increased again to 133 percent of the FPL on September 1, 2007, and increased further to 200 percent of the FPL for 2008.

    Health Insurance Flexibility and Accountability (HIFA) Demonstration Waiver - In 2003, New Jersey received approval from CMS to modify the SCHIP 1115 waiver. The waiver modification standardized coverage to uninsured parents and relative caretakers of children in the Medicaid and SCHIP programs whose incomes are at or below 133 percent of the FPL to that of the parents between 134 percent and 200 percent of the FPL, which was a standard commercial benefit package.

    On July 8, 2008 Governor Corzine signed a health reform bill that will be effective one year after enactment.  This legislation includes a mandate that all children 18 years and younger must have health coverage.  It also increases the eligibility level for parents in the New Jersey Family Care program to 200 percent of FPL. 


Limited-Benefit Plans

  • In 2002, the New Jersey legislature passed legislation which required individual market carriers to offer a limited-benefit plan, called Basic and Essential Health Care Services Plan (B&E).  The B&E plan provides for 90 days of hospitalizations, limited wellness and practitioner visit benefits, and some other limited benefits.  The plan does not include some benefits typically covered by commercial plans such as chemotherapy, outpatient drugs, prenatal care, speech and occupational therapy, home health, or hospice services. Carriers may offer riders that increase the benefits of B&E plans, for example, covering additional services.

    Carriers are able to use modified community rating for B&E plans; however, all other products in New Jersey are pure community rated.   As of 2007, there were over 26,700 members enrolled in the B&E plan.


Dependent Coverage

  • A child covered as a dependent may choose to continue under a parent’s policy until reaching age 30.  The child must have no dependents, and must reside in New Jersey or be a full time student.  Eligible children under the age of 30 who lost coverage due to age in the past, but are currently without coverage, can also elect as a dependent under a parent’s plan, but must pay the same premium.

    The child must pay the premium, which can be as much as 102 percent of the cost of covering a child under the limiting age.  This premium is approximately 60 to 80 percent of the single adult premium for a particular carrier. 

    There are approximately 8,000 young adults with this coverage in the New Jersey commercial health market.  (Public Act 2005 c.375)

State Specific Strategies

  • Family Care Coverage

    New Jersey’s FamilyCare program originally enrolled childless adults up to 100 percent FPL with state-only funds. Enrollment was capped as of September 1, 2001. Currently only those with income at 23 percent FPL may be eligible for coverage.

    NJ FamilyCare ADVANTAGE

    NJ FamilyCare Advantage provides managed care coverage, through Horizon NJ Health, to uninsured children under the age of 19 in families with income greater than 350 percent of the FPL.  If a family chooses to enroll its children into NJ FamilyCare ADVANTAGE, then all children in the family who are eligible for the program must be enrolled.  The family cannot choose which children to enroll.  Families who voluntarily disenrolled from a health benefit program must be without insurance for at least six months.

    Rates for NJ FamilyCare ADVANTAGE are:

    • $137 for one child; 
    • $274 for two children; and
    • $411 for 3 or more children.