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Questions and Answers
Below is a general list of frequently asked questions. If you
don't see your questions listed below, PLEASE call NJ
FamilyCare at 1-800-701-0710 and speak to a Health Benefits
Coordinator. It is suggested that at anytime a family
member contacts a Health Benefits Coordinator, they
keep a record of the day and time and the name of the
person who assisted them.
Can parents/guardians apply for NJ FamilyCare?
NJ FamilyCare is only accepting applications from parents/guardians with work income at
or below 133% of the federal poverty level. For example, parents/guardians in a family
of four, making up to $2,444 per month, may be eligible. However, some parents/guardians
in a family making up to $2,444 may not be eligible because income such as unemployment,
child support and government benefits are counted differently. Prior to March 1, 2010,
parent/guardians with any earnings up to 200% of FPL could be found eligible for NJ FamilyCare.
What does it mean that I have to renew my insurance every 12 months?
Renewal is simply a way of
checking to see if anything has changed
in your family's situation. You may be sent a preprinted form to
confirm your income status and household size or you may
be sent a blank application to fill out. It is
very important that you immediately respond to any written
request so that your insurance coverage will not be lost or interrupted.
How do I know if my family will qualify for NJ FamilyCare?
NJ FamilyCare is affordable health insurance for children and certain
low-income parents. The primary qualifications are simple:
1) they haven't had health insurance
in the past 3 months (with a few exceptions) and 2) your family monthly
income falls within the guidelines listed in the
"Income Eligibility and Cost" section of this web site.
Is it true that applicants for NJ FamilyCare must be without health
insurance for 3 months before they can be eligible?
Yes, this is true. However, there are exceptions to this rule, such as if
you lost your insurance because your place of work went out of business
or you were laid off. Depending on income, other exceptions may apply for
families privately paying for health insurance or for COBRA benefits. We
strongly urge you to call 1-800-701-0710 and speak with a Health Benefits
Coordinator to find out if any exceptions apply to you.
I have a job out of state. The health insurance I
receive is not accessible to my family. Will they qualify for NJ FamilyCare
in spite of the fact that I have insurance?
Yes, if health insurance is not accessible to your
family, they may be eligible to apply for NJ FamilyCare.
I am a single adult. Can I still qualify for the NJ FamilyCare program?
No, to assure that there would be sufficient funding for children, NJ FamilyCare had to stop taking applications for adults and couples without dependent children on September 1,
2001.
My family came to the United States two years ago.
Could they be eligible for NJ FamilyCare?
Children age 18 or under who are lawfully admitted for permanent residence
can be eligible even if they have lived in this country less than five years.
Immigrant parent/guardians who are legal permanent residents of the US must have
had that status for at least five years in order to be eligible for NJ FamilyCare.
Documentation of immigration status will be requested along with the application.
I
don't speak English very well and I am afraid to call.
NJ FamilyCare's 800 number
is linked with a translation service. Whatever your native language is, we
will arrange to have a third person on the line who can speak your
language. They will be there to interpret for you and the Health Benefits
Coordinator. Don't be afraid! Call 1-800-701-0710!
How do I apply?
There are several ways you can apply:
PO Box 8367, Trenton, NJ 08650.
I
really need help completing the application. What should I do?
You can call 1-800-701-0710 and ask for assistance
over the telephone. If you would rather have face to face
assistance, click on the "Need
help enrolling?"
section of this web site and a list of enrollment sites in your county will
come up. Choose a site that offers personal assistance and they will be
able to help you fill out the application.
Can I apply at my County Welfare Agency?
Yes, you can. Actually, if your income is low at this time, it would be
a very good idea to apply at a County Welfare Agency. There
is a possibility that you might be eligible for other programs, such as
food stamps. The representatives at the County Welfare Agency
will be able to help you. You can find your County Welfare Agency's
address and telephone number by going to "Need
help enrolling?" and then click on your county of residence. They
will be listed there.
Do you think I should make a copy of all the paperwork before
I send it?
YES! you should keep a copy of the completed application,
as well as all of the documents.
I cannot make up my mind as to which HMO to select. What
should I do?
First you should check out the list of NJ FamilyCare HMO's,
and see which are available in your County. Then you should contact your
family doctor to see if he or she is participating in one of those HMO's -
be sure to specify NJ FamilyCare when you ask.
If not, we recommend that you call our 800 number
to have one of our Health Benefits Coordinators assist
you. Make a selection even if you are not sure. Not choosing
an HMO will SLOW DOWN your application. Once your family members
are enrolled in NJ FamilyCare, you will have an opportunity
to change your HMO at a later date, if you are not satisfied.
If
I have to pay a monthly premium, how important is it to
send in my check once I receive notice?
It is very important that you send in your payment as soon as you know your
monthly premium. You will receive notice of your premium by
mail. New members cannot be enrolled until the full payment
has been received. Once enrolled you will be billed monthly.
It must be paid in full and on time in order to continue enrollment.
Can
I keep the same doctor I have now?
Yes, if your doctor is a participant of one of the
HMO's providing
services for NJ FamilyCare in your county. Call your
doctor and ask if he or she is providing services for
NJ FamilyCare and if so, under which HMO. Then choose that
HMO as your health care provider.
I
sent in my application four weeks ago and have not heard
anything. What should I do?
If you mailed an application or submitted an online application to the State
Health Benefits Coordinator 4 weeks ago and have not heard anything, call
1-800-701-0710 and ask about the status of your application. Ask for your
policy ID number for future reference. If your application was sent to your
local County Welfare Agency, call them to inquire about the status and to
get your case number.
I have lost my job and can no longer afford the premiums for NJ FamilyCare.
Is there anything I can do to maintain coverage for my children?
You can call 1-800-701-0710 and request a status change. Your family's
eligibility status will then be reevaluated based on current income, and
could result in your paying a lower premium or no premium.
What if my family makes too much money to qualify for NJ FamilyCare?
Parents/guardians at higher income levels can purchase health insurance for their
children at reasonable rates through the NJ FamilyCare ADVANTAGE program
administered by Horizon NJ Health if they qualify. The cost is $144 per
month for one child; $288 per month for two children; and $432 per month for
three or more children. To learn more, please visit
www.horizonnjhealth.com/ourplans/njfamilycareadvantage/about-plan-affordable-health-care-your-children
or call 1-800-637-2997.
Questions and Answers - Changes for Individuals Who Previously Had a Medical Exemption from HMO Enrollment
1. Why do I have to be enrolled in an HMO?
Effective July 1, 2011, many individuals in the NJ FamilyCare/Medicaid program
will be enrolled in Managed Care. New Jersey currently serves 75% of all
Medicaid and NJ FamilyCare clients in managed care health plans and
determined that this is a more efficient and coordinated way to deliver care.
Managed care offers a choice of four HMOs with care coordination. Individuals
with special needs will be assessed for care management when they are enrolled
in their managed care health plan. In addition, managed care health plans offer a
choice of primary care providers and specialists.
2. What is the difference between fee-for-service (FFS) and a managed care
benefit package?
In FFS, participating providers are paid for eligible services on a fixed-fee
schedule by the Medicaid program. In FFS, patients must find their way through
the health care system alone.
In a managed care model, providers are under contract with the managed care
company, also known as an HMO. You will be allowed to choose your HMO and
your primary care provider. Together, you will decide your plan of care so that
you receive all the services and care coordination for which you are eligible.
Someone helps you navigate the health care you will receive.
3. How will my services be transitioned if I am in the middle of a treatment or
service with a provider not participating in my selected HMO?
Your HMO will make sure your health care continues after enrollment into an
HMO without interruption and with the same providers during a continuity of care
period.
Once you are enrolled, the HMO will do an assessment of your medical needs
and any changes to your care plans or providers will be discussed with you at
that time. Most HMOs require that members select a provider from within their
own network.
4. Will my doctors change?
If your doctor/provider is not participating in your HMO's network, they could
request to enroll in the HMO network through the HMO's provider enrollment
process. The HMO will determine which providers will be in their network based
on the provider's credentials and the demand by their members for the services a
provider can offer.
5. Will the doctors/providers be notified if the HMO assessment leads to a
change of services?
All participating NJ FamilyCare/Medicaid providers will be notified of the outcome
of each member's assessment if it results in a change in services.
6. Do I still need to renew my NJ FamilyCare/Medicaid insurance once I
complete my Ready to Enroll packet?
Yes. You must renew your benefits every year.
7. Who do I call if I am not happy with my services through my new HMO?
Once you are enrolled in your HMO, you will receive a member ID card from your
health plan (HMO card). A telephone number is on the back of that card should
you need to reach out to your HMO's Member Services department to discuss
any of your services and needs.
8. Can I change my HMO?
You can change your HMO once a year during the Open Enrollment period from
October 1 to November 15th and, you still have the option of changing your plan for "good cause"
at any time by calling NJ FamilyCare/Medicaid at 1-866-472-5338
(TTY 800-701-0720). When you enroll with an HMO for the first time you
may also change to another HMO within 90 days of enrollment for any reason.
9. I was recently given an exemption; does this still effect me?
Yes. You must select an HMO or one will be chosen for you.
10. Are there any exceptions?
There are no exceptions for anyone enrolled in NJ FamilyCare/Medicaid.
Questions and Answers - Changes to the
Termination of Health Care Coverage for Some Clients
1. Why am I being disenrolled?
Beginning August 1, 2011, NJ FamilyCare will discontinue health insurance coverage
for certain childless adults (adults without children under 19 years of age living in their
household) who are not participants in the State's General Assistance program. The
NJ FamilyCare program was initially created serve uninsured children but over the
years was expanded to a level the state can no longer afford.
2. Who is being disenrolled?
Childless adults (adults without children under 19 years of age living in their
household) who are not participants in the State's General Assistance program, and
who are former Health Access clients.
3. What if I am pregnant or under 18 and I received a disenrollment letter?
If you are pregnant or under 18, you must tell us right away by writing to:
Director of Office of Customer Service
Department of Medical Assistance and Health Services (DMAHS)
P.O. Box 712
Trenton, NJ 08625-0712.
Health coverage may be available to you in a different program if you are pregnant.
In addition, NJ FamilyCare will still be available for children age 18 or under. The
program you are on right now will end for you on June 30, 2011.
4. What if I am over 65 and totally and permanently disabled?
If you are 65 or older or totally and permanently disabled and you received a letter
telling you that your insurance would be ending on July 30, 2011 because of a
change in the law, you should tell us right away by writing to:
Director of Office of Customer Service
Department of Medical Assistance and Health Services (DMAHS)
P.O. Box 712
Trenton, NJ 08625-0712.
5. Who will be eligible for NJ FamilyCare?
Children - US Citizens and Qualified Immigrants, regardless of date of entry, up to
age 19 and up to 350% Federal Poverty Level (FPL).
Parent/Guardian - US Citizens and Qualified Immigrants including those with legal
permanent resident status of at least five years with work income up to 133% of the
FPL could be eligible.
6. Where can I go if I need health care?
Community health clinics offer medical and dental care on a sliding-fee basis. To find
a location near you, visit: www.njpca.org/FQHC/directory.aspx.
You may also wish to look into the New Jersey Hospital Care Payment Assistance
Program (Charity Care). Charity Care provides free or reduced charge care to
patients who receive inpatient and outpatient services at acute care hospitals
throughout the state. Hospital assistance and reduced charge care are available only
for necessary hospital care. For more information about Charity Care, you may
contact the Department of Health and Senior Services at 1-800-367-6543.
Below are patient assistance prescription discount programs offered by
pharmaceutical companies. Each of these programs has its own eligibility criteria,
including prescription benefits status, household income and size, citizenship status,
asset limits and veterans' benefits status. You should review each one carefully to
see if might qualify:
7. Where can I get private health insurance?
You may be eligible for coverage in the commercial individual market. Unlike NJ
FamilyCare, the individual market is not subsidized and that is reflected in the price.
However, there is one subsidized program for uninsured adults with pre-existing
conditions, who are ineligible for Medicaid, called NJ Protect. Information is available
on the Department of Insurance web site at: www.state.nj.us/dobi/reform.htm
8. What is NJ Protect?
NJ Protect is a new health insurance option for uninsured New Jerseyans with preexisting medical conditions.
Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer
superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions
will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.
You must be uninsured for six months and have a pre-existing medical condition.
After six months for information about NJ Protect, please visit:
www.state.nj.us/dobi/division_insurance/njprotect/index.htm
9. What is the NJ FamilyCare Advantage program?
The NJ FamilyCare Advantage program will be available to children only in families
with incomes above 350% of the FPL (over $78,225 a year for a family of 4, or
$6,519 per month). A parent/guardian can purchase coverage for a child under the
age of 19 who is uninsured through Horizon. Please visit:
www.horizonnjhealth.com/ourplans/njfamilycareadvantage/about-plan-affordable-health-care-your-children or call 1-800-637-2997
10. What if I'm in the middle of treatment or will begin treatment shortly for a serious illness?
Prior to your benefits ending, you can contact your HMO for information regarding
potential resources for continuing care needs. The HMO may be aware of resources
in the community to assist families. The telephone number is on the back of the HMO
member ID card. The Medical Assistance Customer Service Office can also be reached at 1-800-356-1561.
Once your HMO coverage ends, medical/behavioral health care services can be
received at the local Federally Qualified Health Center (see question #6: Where can
I go if I need Health Care?).
11. Can parents still apply for NJ FamilyCare?
Certain low-income parents with children under the age of 19 with incomes below
133% FPL ($29,726 for a family of four 2011 Guidelines) may still be eligible for
health coverage and should apply. The NJ FamilyCare program is not closed to
parents with work incomes below 133% FPL. Parents/Guardians in a family making
less than that amount may still not be eligible because income such as
unemployment, child support and government benefits are counted differently for
them.
Restricted Immigrant Adult Parents/Guardians can not re-apply. This group is no
longer eligible. Parents who have attained Legal Permanent Resident Status for at
least five years can apply for coverage as described above.
Questions and Answers -
Changes Effective March 1, 2010
What will change and who will be affected?
Parents/guardians who have not resided in the US as Legal Permanent Residents
for at least five years are no longer eligible for NJ FamilyCare after March 31, 2010.
Parents/guardians requesting health coverage with work income at or below 133%
FPL should apply. For Example, parents/guardians in a family of four, making
up to $2,444 per month, may be eligible. However, some parents/guardians in a
family making up to $2,444 may not be eligible because income such as unemployment,
child support and government benefits are counted differently.
Prior to March 1, 2010, parent/guardians with any earnings up to 200% of FPL
could be found eligible for NJ FamilyCare.
What will not change?
There are no changes for children's enrollment in the NJ FamilyCare Program.
NJ FamilyCare will continue to process eligibility for children.
There are no changes to pregnant women, New Jersey Care...Special Medicaid Programs
for pregnant women through the County Welfare Agencies is still available.
Any pregnant women, regardless of date of entry can apply and be determined
eligible. To find the local County Welfare Agency near you
click here.
Why are these changes happening?
The NJ FamilyCare program is supported by both State and Federal funds. New Jersey is
facing an unprecedented financial crisis and without a change in the program,
we will run out of State funding before the end of this fiscal year.
Who will be eligible for NJ FamilyCare?
Children - US Citizens and Qualified Immigrants, regardless of date of entry, up to age 19 and up to 350% FPL.
Parent/Guardian - US Citizens and Qualified Immigrants including those with legal permanent resident status of at least five years with work income up to 133% of the FLP could be eligible, ($2,444 per month for a family of four).
However, some parents/guardians in a family making up to $2,444 may not be eligible because income such as unemployment, child support and government benefits are counted differently.
Pregnant women are still eligible for services through their local
County Welfare Agency.
Where can I go if I need health care?
Federally Qualified Health Centers (FQHCs) offer medical care through a number of community
health centers operating throughout the state. These centers are federally supported and
offer a wide array of medical, dental and other services on a sliding-fee basis. To find a
location near you, visit www.njpca.org/FQHC/directory.aspx.
Where can I get health insurance?
You may be eligible for coverage in the commercial individual market. Unlike NJ FamilyCare,
the individual market is not subsidized, and the prices reflect that. Information is
available on the Department of Insurance web site at:
www.state.nj.us/dobi/reform.htm.
What if I'm in the middle of treatment or will begin treatment shortly for a serious illness?
NJFC regrets that the insurance had to end for many of our beneficiaries. If your
coverage has been discontinued. Prior to termination, you can contact your HMO
for information regarding potential resources for continuing care needs. The HMO
may be aware of resources to assist families. The telephone number is on the back
of the HMO Insurance ID card. The Medicaid Customer Service Office can also be
reached at 1-800-356-1561.
What if I'm Pregnant?
Services for Pregnant Women are available through the local County Welfare Agency.
Contact the respective local County Welfare Agency in your area.
Pregnant women on NJ FamilyCare through the State Vendor should contact
NJ FamilyCare at 1-800-701-0710 to advise them of the pregnancy.
Can Parents still apply for NJ FamilyCare?
US Citizen Parents/Guardians and Qualified Adult Immigrants: Certain low-income
parents with work incomes below 133% FPL ($2,444 per month for a family of four
using 2009 Guidelines) may still be eligible for health coverage, and should apply.
However, some parents/guardians in a family making up to $2,444 may not be eligible
because income such as unemployment, child support and government benefits are counted
differently. Prior to March 1, 2010, parent/guardians with any earnings up to 200% of
FPL could be found eligible for NJ FamilyCare.
The NJ FamilyCare program is not closed to parents with work income below 133% FPL.
Restricted Immigrant Adult Parents/Guardians are no longer eligible. Parents who
have attained Legal Permanent Resident Status for at least five years can apply
for coverage as described above.
What if I disagree with the termination from NJ FamilyCare which was based on my immigration status?
You should write to the Department of Medical Assistance and Health Services (DMAHS)
Office of Customer Service, P.O. Box 712, Trenton, N.J. 08625-0712, include a copy
of any documentation that proves your legal permanent residency of at least five (5) years.