Page 21

Effective Date: April 1, 2009

Approval Date: ____________ 18

INCOME DISREGARDS Gross Income as % of FPL Income Disregards (as a % of FPL) NJ FamilyCare Plan 133 Medicaid disregards apply A 150 0 B 200 0 C 250 50 D 300 100 D 350 150 D

In addition, all wages paid by the Census Bureau for temporary employment related to Census 2000 activities are excluded, as are monetary rewards paid by the Division of Medical Assistance and Health Services for information leading to the recovery of at least $100.00 from individuals or entities that have engaged in health care-related fraud or abuse.

4.1.4

Resources (including any standards relating to spend downs and disposition of resources): 4.1.5

Residency (so long as residency requirement is not based on length of time in state): Must be a current New Jersey resident 4.1.6

Disability Status (so long as any standard relating to disability status does not restrict eligibility): 4.1.7

Access to or coverage under other health coverage:

Based on guidance provided by CMS, a child who meets the eligibility criteria for the expanded Medicaid program (NJ FamilyCare Plan A) is not eligible if the child is covered by other health coverage. This ineligibility for the expanded Medicaid coverage is a federal statutory exception to the entitlement requirements that would otherwise apply under Title XIX, where the other insurance would be treated as a third party resource with Medicaid remaining payer of last resort.

Unlike NJ FamilyCare Plans B, C or D, under the Medicaid expansion, (NJ FamilyCare Plan A) there is no requirement that the child be uninsured for a 3 month period. This is due to “crowd-out” being of less concern in the lower income population. In addition, it tends to diminish the disparity between the children covered under the Medicaid expansion and other Medicaid-eligible children.

For NJ FamilyCare Plans B and C, a child must be uninsured for a minimum of three months. Exceptions are made for children losing Medicaid eligibility and who have no other health care coverage at the time of termination. Exceptions are also made to the three-month requirement in certain limited circumstances (if, for example, prior coverage was lost because an employer went out of business or the employee was laid off or changed jobs and does not have access to