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Effective Date: April 1, 2009

Approval Date: ____________ 19

affordable coverage in the new job) where crowd-out concerns are not an issue. Also, a child is not determined ineligible if the child was previously covered under an individual health benefits plan or COBRA plan preceding application for NJ FamilyCare and the child had not been voluntarily disenrolled from employer- sponsored group insurance coverage during the three-month period prior to applying for NJ FamilyCare.

A child with income greater than 200% of the federal poverty level who meets the criteria for NJ FamilyCare coverage under Plan D must be uninsured for a minimum of 3 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 3 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) where crowd- out concerns are not at issue).

There is no other requirement regarding access to other health coverage.

4.1.8

Duration of eligibility:

The State provides continuous coverage for the 12 months between redeterminations, and has done so since September 2000. Redeterminations will be conducted at 12-month intervals for children eligible under the Medicaid expansion (NJ FamilyCare Plan A) and at 12-month intervals for children eligible under NJ FamilyCare Plans B, C or D. Under both the Medicaid expansion (NJ FamilyCare Plan A) and NJ FamilyCare Plans B, C or D, eligibility will be terminated if income exceeds the allowable threshold, based on information provided/obtained during the redetermination process. Termination is effective the first day of the month following the month in which the income level is exceeded.

4.1.9

Other standards (identify and describe):

Title XXI is a federal means tested program and therefore subject to the same alien restrictions as the Title XIX program. Accordingly, benefits are available only to children who are qualified aliens and who are not subject to the five-year bar or who have a parent on active military duty or who is a veteran. Qualified aliens include aliens lawfully admitted for permanent residence, asylees, refugees, aliens paroled into the United States for a period of at least 1 year, aliens whose deportation is being withheld, conditional entrants, and Cuban/Haitians.

4.1-P. The following standards may be used to determine eligibility of targeted low-income pregnant women for health assistance under the plan. (Section 2112).

4.1.1-P. Geographic area served by the Plan: Statewide