NJ FamilyCare is a state program that provides free and low cost health insurance for uninsured children and many adults in New Jersey. Enrollment generally must be renewed every 12 months, and the program has some eligibility requirements. But children are financially eligible with family incomes up to 350% of the poverty level ($64,085 for a family of three). See Income Eligibility and Cost (from NJ FamilyCare). There is also an insurance program, NJ FamilyCare ADVANTAGE (from Horizon Blue Cross Blue Shield of New Jersey), for uninsured children in families with higher incomes. FamilyCare also covers eligible pregnant women and children’s parents or caretakers to 200% of the poverty level ($36,620 for a family of three).
For most enrollees, FamilyCare provides coverage for comprehensive health care services through the networks of providers in six commercial HMOs (health maintenance organizations) throughout the state. See Choosing an HMO on the FamilyCare Web site. Based on their income level, participants are enrolled in one of four different benefit plans (Plans A, B, C, and D). With some restrictions, most plans cover full hospital and non-hospital-based benefits, including physician services, dental, prescription drugs, transportation, behavioral health, lab tests, eyeglasses, physical and occupational therapy, etc.
As of July 1, 2009, only those children whose family income exceeds 200% of the poverty level pay monthly premiums. Please see the chart on the FamilyCare Web site for current income eligibility and out-of-pocket costs. Eligible children with family income below 200% of the poverty level have no premiums.
Because NJ FamilyCare is government funded, the program has frozen new applications at different times in the past based on available state and federal funding. Some FamilyCare plans have been closed for new applications for several years, but the original enrollees remain eligible for as long as they do not exceed the plan’s income levels. Because the state can freeze new applications if there are funding problems (except for people below the AFDC-related Medicaid income limit), parents/caretakers who think that they and/or their children may be eligible for NJ FamilyCare should apply immediately.
People who are denied eligibility, terminated from the program, or denied or delayed covered services have the right to either a Fair Hearing or to file a formal Grievance. If you have experienced any adverse actions related to NJ FamilyCare and want free legal assistance, please contact your nearest Legal Services office or call LSNJ-LAW™, Legal Services of New Jersey’s statewide, toll-free legal hotline, at 1-888-LSNJ-LAW (1-888-576-5529) to see if you are eligible. Hotline hours are Monday through Friday, 8:00 a.m. to 5:30 p.m. If you are not eligible for assistance from Legal Services, the hotline will refer you to other possible resources.
This information last reviewed 2/4/10. |
