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Effective Date: April 1, 2009

Approval Date: ____________ 25

complete an additional form or application. Also see outreach efforts detailed in section 2.

4.4.4 The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution. Coverage provided to children in families at or below 200% FPL (Plans A, B and C): The NJ FamilyCare application (used for initial application and redetermination), has been redesigned to contain a separate section to be completed for each child applicant. The application section for each child asks for information regarding that child's current health insurance, and whether the insurance is from the school, COBRA, an employer, a custodial parent, a non- custodial parent, Medicare and/or Medicaid. The application also asks whether the child had health insurance within the last three months, and if so, whether it ended, and why it ended. The minimum period without coverage under a group health plan is three months. The NJ FamilyCare program will collect this data from all applications and redeterminations regarding the health coverage available to a family, and sends it to the premium support program. The premium support program staff contact the family, gather information and review the information regarding substitution, employer contribution and cost-effectiveness in order to determine whether participation in the premium support program is appropriate for a particular child.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable. Coverage provided to children in families over 200% and up to 250% FPL (Plan D): The NJ FamilyCare application (used for initial application and redetermination), has been redesigned to contain a separate section to be completed for each child applicant. The application section for each child asks for information regarding that child's current health insurance, and whether the insurance is from the school, COBRA, an employer, a custodial parent, a non- custodial parent, Medicare and/or Medicaid. The application also asks whether the child had health insurance within the last three months, and if so, whether it ended, and why it ended. The minimum period without coverage under a group health plan is three months. The NJ FamilyCare program will collect this data