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Effective Date: April 1, 2009

Approval Date: ____________ 21

The State makes the same assurances as to pregnant women eligible pursuant to Section 4.1-P :

4.2.1

These standards do not discriminate on the basis of diagnosis. 4.2.1

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.1

These standards do not deny eligibility based on a child having a pre-existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

4.3.1 Describe the state's policies governing enrollment caps and waiting lists (if any). (Section 2106(b)(7)) (42CFR 457.305(b)) Check here if this section does not apply to your state.

An application can be requested via a toll-free number operated under contract for the state or obtained through an outreach source, or obtained from the county board of social services. The application is the same for those applying for NJ FamilyCare Plan A (Medicaid expansion) or NJ FamilyCare Plans B, C and D. The form is designed to ensure all federal requirements are met, but the application process is simplified as much as possible.

In addition, a computer-assisted application may be filed with any agency that is on the One Ease-E Link network and which has indicated a desire to provide that service. One Ease-E Link is capable of screening individuals for eligibility under NJ FamilyCare Plans A, B, C and D and transmitting an electronic application including documentation to the state vendor for processing.

For children eligible under the Medicaid expansion (NJ FamilyCare Plan A), the application can be mailed in to a state vendor or the County Board of Social Services or the client may complete the application through the face-to-face process at the County Board of Social Services. If the application is mailed in, it is screened for completeness. If incomplete, any missing information will be requested. Potential beneficiaries who do not respond to the request within 60 days, will be outreached by mail. If there is no response within 30 days, they will be referred to an outreach worker for a telephone follow-up. The state makes a final determination regarding completed applications processed by the vendor.

Eligibility under the Medicaid expansion (NJ FamilyCare Plan A) is applied back to the date of the application. Eligibility is effective the first day of the first month in which the person is found eligible. Retroactive eligibility is available to cover unpaid medical bills for the three months prior to the date of application if the