NJ FamilyCare to Resume Eligibility Reviews April 1st; Members Should Update Information

NJ FamilyCare, the state’s health insurance program, will be required by federal law to restart eligibility reviews as of April 1 – and members should remember to ensure the state has their correct contact information, or they can risk being removed from the program.

The federal government in March 2020 temporarily waived Medicaid and Children’s Health Insurance Program (CHIP) requirements to help prevent people from losing health coverage during the pandemic.

Under the federal FY23 Omnibus spending bill passed by Congress and signed by President Biden in late December, states must resume eligibility reviews as of April 1.

The Department of Human Services must complete eligibility reviews within twelve months for all current members.

To ensure reviews are processed in a timely manner, members will be contacted on a rolling basis throughout this period about how to renew coverage.

To update their contact information, NJ FamilyCare members should call their NJ FamilyCare health plan or 1-800-701-0710.

All members should make sure their address, email and phone number are up to date with NJ FamilyCare, and to be on the lookout for a renewal letter in the mail over the coming months, which should be filled out and returned by the deadline to help avoid any gap in your coverage.

NJ FamilyCare is New Jersey’s publicly funded health insurance program that includes CHIP, Medicaid and Medicaid expansion populations. It provides free or low-cost coverage to about 2.2 million New Jerseyans, or about 24 percent of state residents and about half of all New Jersey children.

Resuming eligibility checks means some NJ FamilyCare members may no longer qualify and will be disenrolled. 

Those who no longer qualify because their income is too high may be eligible to obtain health coverage through New Jersey’s Official Health Insurance Marketplace, Get Covered New Jersey, and may be able to get help paying for premiums. 

Some individuals may no longer qualify for Medicaid, but will qualify for Medicare. 

In both situations, NJ FamilyCare will assist by transferring account information to the marketplace or to a Medicare counselor for review.

Additionally, some consumers who are no longer eligible for NJ FamilyCare may be eligible for health insurance from an employer.

Losing Medicaid or CHIP coverage is called a Qualifying Life Event, which allows consumers to enroll in a marketplace plan outside of the regular open enrollment period.

Members who are found to be ineligible will also have the right to appeal through the fair hearings process, a process between Medicaid and the Office of Administrative Law.

Human Services will be coordinating with GetCoveredNJ to assist members whose incomes exceed eligibility limits with gaining new coverage and will automatically transfer to GetCoveredNJ the account information of certain consumers.

Consumers whose information is transferred will be contacted by GetCoveredNJ, where they can claim their account, complete their pre-filled application to determine eligibility for financial help, and enroll in coverage. Consumers who lose NJ FamilyCare coverage as a result of not completing their renewal form will not have their information transferred to GetCoveredNJ.

To avoid duplicate coverage and potential tax implications, any consumer not automatically transferred should apply for coverage through GetCoveredNJ after they have received notification from NJ FamilyCare that they are no longer eligible for NJFamilyCare coverage.

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