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www.njfamilycare.org
(800) 701-0710TTY 1-800-701-0720(For hearing impaired individuals)
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Uninsured FamiliesUninsured FamiliesGet sick more often Get sick more often
Children miss more schoolChildren miss more school Parents miss work/lost wagesParents miss work/lost wages
Pay more for healthcare out of pocketPay more for healthcare out of pocket
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Impact on CommunitiesImpact on Communities
High hospitalization ratesHigh hospitalization rates
Overcrowded Emergency RoomsOvercrowded Emergency Rooms
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For families who cannot pay for private For families who cannot pay for private health insurance health insurance
Eligibility is based on family size and Eligibility is based on family size and incomeincome
Assets are not countedAssets are not counted
Purpose:Purpose: To give uninsured families access to To give uninsured families access to affordable health coverage.affordable health coverage.
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Awareness of NJ FamilyCareAwareness of NJ FamilyCare More than 500,000 children are currently enrolled More than 500,000 children are currently enrolled
At least 90,000 more children in NJ may be At least 90,000 more children in NJ may be eligible eligible
Almost half the families with eligible uninsured Almost half the families with eligible uninsured children do not believe NJ FamilyCare applies to children do not believe NJ FamilyCare applies to themthem
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Children’s Eligibility At A Children’s Eligibility At A GlanceGlance
18 years old or younger18 years old or younger
Income meets program guidelinesIncome meets program guidelines
New Jersey residentNew Jersey resident
US citizen or legal permanent residentUS citizen or legal permanent resident
Uninsured for at least 3 months prior to Uninsured for at least 3 months prior to application* (exceptions apply*)application* (exceptions apply*)
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*Exceptions to 3 Month Rule*Exceptions to 3 Month Rule
If family is 133% of FPL or belowIf family is 133% of FPL or below
Lost job through no fault of their ownLost job through no fault of their own
COBRA has expiredCOBRA has expired
200% of FPL or below can apply with 200% of FPL or below can apply with COBRA or private insuranceCOBRA or private insurance
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As of September 1, 2005As of September 1, 2005NJ FamilyCare is available toNJ FamilyCare is available to
*Parents*Parents (with children 18 or younger)(with children 18 or younger)
&&
ChildrenChildren (18 or younger)(18 or younger)
*For parents to qualify, their income must be at or below 100% of the Federal Poverty Level (FPL)
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Maximum Gross (before taxes) Maximum Gross (before taxes) Income for Parent EnrollmentIncome for Parent Enrollment
Family Size
Annual Income
Monthly Income
2 3 4 5 6 7 8
Each additional
$13,200 $16,600 $20,000 $23,400 $26,800 $30,200 $33,600 $3,400
$1,100 $1,384 $1,667 $1,950 $2,234 $2,517 $2,801 $284
100% FPL
If the parent’s income is too high, they can still apply for their child(ren), If the parent’s income is too high, they can still apply for their child(ren), if the child is not already enrolled.if the child is not already enrolled.
The maximum income for children enrollment is much higher.The maximum income for children enrollment is much higher.
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Continuum of CareContinuum of Care
Healthy ChildrenHealthy ChildrenHealthy ParentsHealthy Parents
Healthy FamiliesHealthy Families
=
=
=
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Year 2006 Income Guidelines*
Maximum Annual/Monthly
Income
Family Size One Child
Family Size 2 people
Family Size 3 people
Family Size 4 people
Family Size 5 people
Family Size 6 people
Family Size 7 people
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Premiums
Copayments
100%
Poverty Level
Up to $9,800
$817
Up to $13,200
$1,100
Up to $16,600
$1,384
Up to $20,000
$1,667
Up to $23,400
$1,950
Up to $26,800
$2,234
Up to $30,200
$2,517
No premium
No copay
133%
Poverty Level
$13,034
$1,087
$17,556
$1,463
$22,078
$1,840
$26,600
$2,217
$31,122
$2,594
$35,644
$2,971
$40,166
$3,348
No premium
No copay
150%
Poverty Level
$14,700
$1,225
$19,800
$1,650
$24,900
$2,075
$30,000
$2,500
$35,100
$2,925
$40,200
$3,350
$45,300
$3,775
No premium
No copay
200%
Poverty Level
$19,600
$1,634
$26,400
$2,200
$33,200
$2,767
$40,000
$3,334
$46,800
$3,900
$53,600
$4,467
$60,400
$5,034
$17.50 monthly
per family
$5 - $10
250%
Poverty Level
$24,500
$2,042
$33,000
$2,750
$41,500
$3,459
$50,000
$4,167
$58,500
$4,875
$67,000
$5,584
$75,500
$6,292
$35 monthly
per family
$5 - $35
300%
Poverty Level
$29,400
$2,450
$39,600
$3,300
$49,800
$4,150
$60,000
$5,000
$70,200
$5,850
$80,400
$6,700
$90,600
$7,550
$70
monthly per family
$5 - $35
350%
Poverty Level
$34,300
$2,859
$46,200
$3,850
$58,100
$4,842
$70,000
$5,834
$81,900
$6,825
$93,800
$7,817
$105,700
$8,809
$117 monthly
per family
$5 - $35
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What Services Are Covered?What Services Are Covered? Physician VisitsPhysician Visits Emergency CareEmergency Care Preventative ServicesPreventative Services Vision & Hearing ScreeningsVision & Hearing Screenings X-raysX-rays Dental (in most cases)Dental (in most cases) PrescriptionsPrescriptions Mental Health ServicesMental Health Services Hospitalizations & more…Hospitalizations & more…
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PLANS A . .B . . C . . D . .PLANS A . .B . . C . . D . .
Maximum Annual/Monthly
Income
Family Size One Child
Family Size 2 people
Family Size 3 people
Family Size 4 people
Family Size 5 people
Family Size 6 people
Family Size 7 people
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
Annual Monthly Income
100%
Poverty Level
Up to $9,800
$817
Up to $13,200
$1,100
Up to $16,600
$1,384
Up to $20,000
$1,667
Up to $23,400
$1,950
Up to $26,800
$2,234
Up to $30,200
$2,517
PARENTS Plan D
133%
Poverty Level
$13,034
$1,087
$17,556
$1,463
$22,078
$1,840
$26,600
$2,217
$31,122
$2,594
$35,644
$2,971
$40,166
$3,348
Plan A
150% Poverty Level
$14,700
$1,225
$19,800
$1,650
$24,900
$2,075
$30,000
$2,500
$35,100
$2,925
$40,200
$3,350
$45,300
$3,775
Plan B
200% Poverty Level
$19,600
$1,634
$26,400
$2,200
$33,200
$2,767
$40,000
$3,334
$46,800
$3,900
$53,600
$4,467
$60,400
$5,034
Plan C
250% Poverty Level
$24,500
$2,042
$33,000
$2,750
$41,500
$3,459
$50,000
$4,167
$58,500
$4,875
$67,000
$5,584
$75,500
$6,292
Plan D
300% Poverty Level
$29,400
$2,450
$39,600
$3,300
$49,800
$4,150
$60,000
$5,000
$70,200
$5,850
$80,400
$6,700
$90,600
$7,550
Plan D
350% Poverty Level
$34,300
$2,859
$46,200
$3,850
$58,100
$4,842
$70,000
$5,834
$81,900
$6,825
$93,800
$7,817
$105,700
$8,809
Plan D
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When Does coverage Begin?When Does coverage Begin? Plan APlan A
•Covered from the first day of the month application is Covered from the first day of the month application is filedfiled•Automatically enrolled in an HMO if one is not Automatically enrolled in an HMO if one is not chosenchosen
Plan BPlan B No coverage until family is enrolled in an HMONo coverage until family is enrolled in an HMO
Plans C & DPlans C & D No coverage until premium is paid & family is No coverage until premium is paid & family is enrolled in an HMOenrolled in an HMO
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Newly Enrolled ParentsNewly Enrolled Parents Newly enrolled parents will receive Newly enrolled parents will receive
Plan D coveragePlan D coverage No premium No premium Very similar to commercial insuranceVery similar to commercial insurance
Parents can call 1-800# for complete Parents can call 1-800# for complete description of Plan Ddescription of Plan D
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PresumptivePresumptive EligibilityEligibility Uninsured children needing immediate care from Uninsured children needing immediate care from
a hospital or Federally Qualified Health Center a hospital or Federally Qualified Health Center can apply for Presumptive Eligibility *(PE).can apply for Presumptive Eligibility *(PE).
Immigrant children must have resided in the US for Immigrant children must have resided in the US for at at least 5 years to apply for PE (not for NJ least 5 years to apply for PE (not for NJ FamilyCare).FamilyCare).
A copy of the completed PE application will be A copy of the completed PE application will be used to apply for full NJ FamilyCare coverage. used to apply for full NJ FamilyCare coverage. If the family has an application pending with NJ If the family has an application pending with NJ FamilyCare at the time they apply for PE, write: FamilyCare at the time they apply for PE, write: ‘‘NJ FamilyCare application pending’NJ FamilyCare application pending’ on the PE on the PE application.application.
*See next slide for further explanation of Presumptive Eligibility
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What is Presumptive Eligibility (PE)?What is Presumptive Eligibility (PE)? PE provides temporary health insurance for uninsured PE provides temporary health insurance for uninsured
children who need immediate treatment.children who need immediate treatment.
Hospitals and Federally Qualified Health Centers Hospitals and Federally Qualified Health Centers (FQHCs) complete the application based on the initial (FQHCs) complete the application based on the initial determination that the child determination that the child appearsappears eligible for NJ eligible for NJ FamilyCare. No documentation is required for PE.FamilyCare. No documentation is required for PE.
Families will receive a letter requesting documentation Families will receive a letter requesting documentation to complete enrollment into NJ FamilyCare. to complete enrollment into NJ FamilyCare.
For Presumptive Eligibility sites in your area, please For Presumptive Eligibility sites in your area, please call NJ FamilyCare at 1-800-701-0710.call NJ FamilyCare at 1-800-701-0710.
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The ApplicationThe Application
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Section 1- HouseholdSection 1- Household
First person listed is considered “Head First person listed is considered “Head of Household”of Household”
Social Security numberSocial Security number•Must provide SSN for anyone applying Must provide SSN for anyone applying for NJ FamilyCarefor NJ FamilyCare
Family Group: Family Group: Children up to age 21, Children up to age 21, parents/guardians, and their spouseparents/guardians, and their spouse
2020
Section 2- Income InformationSection 2- Income Information
Report Income for every job & each personReport Income for every job & each person
Include working children ages 16-20Include working children ages 16-20
Include both Include both Work Work and and Other Other incomeincome
Under the Table jobsUnder the Table jobs•Employee Verification LetterEmployee Verification Letter•Zero Income requires a Letter of SupportZero Income requires a Letter of Support
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Section 3 – HMO SelectionSection 3 – HMO Selection
Select An HMOSelect An HMO
Choose a DoctorChoose a Doctor
First Family Visit to Doctor First Family Visit to Doctor
Promote Preventative MedicinePromote Preventative Medicine
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Required DocumentsRequired Documents
Proof of IncomeProof of Income• 1 pay stub for the most recent month 1 pay stub for the most recent month
availableavailable• Proof of other income (not needed for child Proof of other income (not needed for child
support/alimony)support/alimony)
Proof of Qualified Immigrant statusProof of Qualified Immigrant status
Proof of other Insurance (if applicable)Proof of other Insurance (if applicable)• Or letter stating the insurance endedOr letter stating the insurance ended
Remember to make a Remember to make a COPYCOPY for yourself* for yourself*
*Only send in copies of the documents, do not send originals.
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General Application ConcernsGeneral Application Concerns Fill in Fill in EVERY EVERY boxbox
Print ClearlyPrint Clearly
Fill in the Enrollment Site #: Fill in the Enrollment Site #: DFD576DFD576•Place Place youryour initials under the blue box initials under the blue box
Review the application with the familyReview the application with the family
Make sure family signs the applicationMake sure family signs the application
Order more applications and materialsOrder more applications and materials
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Family Worker ResponsibilitiesFamily Worker Responsibilities
Assess families health insurance statusAssess families health insurance status
Assist families with completing application when Assist families with completing application when requestedrequested
Monitor status of applicationMonitor status of application
Provide follow-up if neededProvide follow-up if needed
Report number of applications completed Report number of applications completed monthly to FWCmonthly to FWC
Maintain supply of applicationsMaintain supply of applications
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FWC ResponsibilitiesFWC Responsibilities
Provide NJ FamilyCare training to new Provide NJ FamilyCare training to new Family WorkersFamily Workers
Provide on-going technical assistance Provide on-going technical assistance for NJ FamilyCare to Family Workersfor NJ FamilyCare to Family Workers
Report number of NJ FamilyCare Report number of NJ FamilyCare applications completed on a quarterly applications completed on a quarterly basis to DFDbasis to DFD
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Chain of EventsChain of Events
Family Worker CoordinatorFamily Worker CoordinatorFamily WorkerFamily Worker
NJ FamilyCare VendorNJ FamilyCare Vendor
2
3
1
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Follow-UpFollow-Up Keep a copy of the application and all Keep a copy of the application and all
documentsdocuments
Allow 2-3 months for eligibility decisionAllow 2-3 months for eligibility decision
Make yourself accessible to familiesMake yourself accessible to families
Explain the uses for the (800) 701-0710Explain the uses for the (800) 701-0710
Explain Yearly Renewal ProcessExplain Yearly Renewal Process
Encourage families to report changes Encourage families to report changes in: Household – Address – Phone #in: Household – Address – Phone #
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F.Y.I.F.Y.I. NJ FamilyCare offers NJ FamilyCare offers Continuous Continuous
EligibilityEligibility for 12 months. for 12 months.
This means:This means: If the family’s income If the family’s income increasesincreases or family size or family size
decreasesdecreases, it does not have to be reported until , it does not have to be reported until it is time to renew. it is time to renew.
However, if the family’s income However, if the family’s income decreasesdecreases, or , or family size family size increasesincreases, they should report it , they should report it right away. It may result in their being placed right away. It may result in their being placed in a plan with a lower premium or no premium.in a plan with a lower premium or no premium.
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Applying OnlineApplying Online You can help families fill out the NJ You can help families fill out the NJ
FamilyCare application online at:FamilyCare application online at: www.njfamilycare.orgwww.njfamilycare.org www.njhelps.orgwww.njhelps.org
You must You must still follow up with the familystill follow up with the family, , even if they apply online!even if they apply online! The online application requires the same The online application requires the same
documentation as the paper applicationdocumentation as the paper application
A confirmation letter will be sent to the A confirmation letter will be sent to the applicant requesting the necessary applicant requesting the necessary documentation.documentation.
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Case StudyCase Study
After a short breakAfter a short break
We will do a Sample Case .We will do a Sample Case .
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Application ToolkitApplication Toolkit LiteratureLiterature
FAQ’sFAQ’s
Documentation ChecklistDocumentation Checklist
Immigrant Eligibility Quick SheetImmigrant Eligibility Quick Sheet
Hints and SuggestionsHints and Suggestions
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Questions Questions
& &
AnswersAnswers
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NJ FamilyCare JeopardyNJ FamilyCare Jeopardy
Application Application DetailsDetails
EligibilityEligibility
RequirementsRequirements
Follow-upFollow-up Misc. Misc. QuestionsQuestions
PenPen PenPen PenPen PenPen
LanyardLanyard LanyardLanyard LanyardLanyard LanyardLanyard
Tote BagTote Bag Tote BagTote Bag Tote BagTote Bag Tote BagTote Bag
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www.njfamilycare.org
(800) 701-0710
THANK YOU FOR COMING!
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