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Effective Date: April 1, 2009

Approval Date: ____________ 26

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.

New Jersey monitors the actual incidence of substitution, assessing the extent to which substitution, or "crowd-out," is experienced. If the State finds that NJ FamilyCare is covering substantial numbers of children who were covered under employer-sponsored plans, the State will consider additional strategies to prevent substitution, or "crowd-out."

4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution. Coverage provided to children in families above 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 collects 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.

4.4.4.4. If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period. The state provides coverage under a premium assistance program in its State Plan and under its 1115 waiver program. The minimum