Bill > S3490

Introduced Session

This bill requires the Commissioner of Human Services to establish an eligibility determination timeliness standard for determining initial eligibility of families and children under the Medicaid and NJ FamilyCare programs. This bill also extends the period of time in which a beneficiary may fail to pay a premium required for NJ FamilyCare coverage before coverage is terminated. Specifically, this bill requires the eligibility determination timeliness standard to provide for a new applicant's determination of eligibility as soon as all factors of eligibility are met and verified, but not later than 21 days from the date of the initial application submission. When the determination of eligibility is made later than 21 days from the date of the initial application submission, the eligibility determination agency responsible for the intake and processing of the application must provide the applicant written notification, immediately upon the expiration of the 21-day processing period, setting forth the specific reasons for the delay. The commissioner is further required to report to the Governor and the Legislature on the application processing performance of eligibility determination agencies pursuant to this bill and make any recommendations the commissioner deems appropriate no later than one year following the bill's enactment, and annually thereafter. This bill also provides that a failure to pay a premium required for NJ FamilyCare coverage for three consecutive months will result in the termination of coverage. By current regulation, N.J.A.C. 10:49-9.2 and 10:79-6.7, coverage is terminated the month after a monthly plan premium payment is missed. The current law, as modified by federal regulation, provides that an individual may be "locked out" or ineligible to apply for coverage if that person was "voluntarily disenrolled" from coverage within three months of their application to the program. This bill, by providing that coverage be terminated after three consecutive missed premium payments, instead of after one missed premium payment, will reduce the number of individuals who lose coverage, and accordingly, prevent individuals from being "locked-out" of or ineligible to apply for reinstatement of coverage due to a single missed premium payment.

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Joe Cryan (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 02/21/2019)