1 (800) TTY (For hearing impaired individuals)

2 Uninsured Families  Get sick more often  Children miss more school  Parents miss work/lost wages  Pay more for healthcare out of pocket

3 Impact on Communities  High hospitalization rates  Overcrowded Emergency Rooms

4  For families who cannot pay for private health insurance  Eligibility is based on family size and income  Assets are not counted Purpose: To give uninsured families access to affordable health coverage.

5 Awareness of NJ FamilyCare  More than 500,000 children are currently enrolled  At least 90,000 more children in NJ may be eligible  Almost half the families with eligible uninsured children do not believe NJ FamilyCare applies to them

6 Children’s Eligibility At A Glance  18 years old or younger  Income meets program guidelines  New Jersey resident  US citizen or legal permanent resident  Uninsured for at least 3 months prior to application* (exceptions apply*)

7 *Exceptions to 3 Month Rule  If family is 133% of FPL or below  Lost job through no fault of their own  COBRA has expired  200% of FPL or below can apply with COBRA or private insurance

8 As of September 1, 2005 NJ FamilyCare is available to *Parents (with children 18 or younger) & Children (18 or younger) *For parents to qualify, their income must be at or below 100% of the Federal Poverty Level (FPL)

9 Maximum Gross (before taxes) Income for Parent Enrollment 100% FPL  If the parent’s income is too high, they can still apply for their child(ren), if the child is not already enrolled.  The maximum income for children enrollment is much higher.

10 Continuum of Care Healthy Children Healthy Families Healthy Parents = = =

11 Year 2006 Income Guidelines*

12 What Services Are Covered?  Physician Visits  Emergency Care  Preventative Services  Vision & Hearing Screenings  X-rays  Dental (in most cases)  Prescriptions  Mental Health Services  Hospitalizations & more…

13 PLANS A..B.. C.. D..

14 When Does coverage Begin?  Plan A Covered from the first day of the month application is filedCovered from the first day of the month application is filed Automatically enrolled in an HMO if one is not chosenAutomatically enrolled in an HMO if one is not chosen  Plan B No coverage until family is enrolled in an HMO  Plans C & D No coverage until premium is paid & family is enrolled in an HMO

15 Newly Enrolled Parents  Newly enrolled parents will receive Plan D coverage No premium No premium Very similar to commercial insurance Very similar to commercial insurance  Parents can call 1-800# for complete description of Plan D

16 Presumptive Eligibility  Uninsured children needing immediate care from a hospital or Federally Qualified Health Center can apply for Presumptive Eligibility *(PE). Immigrant children must have resided in the US for at least 5 years to apply for PE (not for NJ FamilyCare).  A copy of the completed PE application will be used to apply for full NJ FamilyCare coverage. If the family has an application pending with NJ FamilyCare at the time they apply for PE, write: ‘NJ FamilyCare application pending’ on the PE application. If the family has an application pending with NJ FamilyCare at the time they apply for PE, write: ‘NJ FamilyCare application pending’ on the PE application. *See next slide for further explanation of Presumptive Eligibility

17 What is Presumptive Eligibility (PE)?  PE provides temporary health insurance for uninsured children who need immediate treatment.  Hospitals and Federally Qualified Health Centers (FQHCs) complete the application based on the initial determination that the child appears eligible for NJ FamilyCare. No documentation is required for PE.  Families will receive a letter requesting documentation to complete enrollment into NJ FamilyCare.  For Presumptive Eligibility sites in your area, please call NJ FamilyCare at

18 The Application

19 Section 1- Household  First person listed is considered “Head of Household”  Social Security number Must provide SSN for anyone applying for NJ FamilyCareMust provide SSN for anyone applying for NJ FamilyCare  Family Group: Children up to age 21, parents/guardians, and their spouse

20 Section 2- Income Information  Report Income for every job & each person  Include working children ages  Include both Work and Other income  Under the Table jobs Employee Verification LetterEmployee Verification Letter Zero Income requires a Letter of SupportZero Income requires a Letter of Support

21 Section 3 – HMO Selection  Select An HMO  Choose a Doctor  First Family Visit to Doctor  Promote Preventative Medicine

22 Required Documents  Proof of Income 1 pay stub for the most recent month available1 pay stub for the most recent month available Proof of other income (not needed for child support/alimony)Proof of other income (not needed for child support/alimony)  Proof of Qualified Immigrant status  Proof of other Insurance (if applicable) Or letter stating the insurance endedOr letter stating the insurance ended  Remember to make a COPY for yourself* *Only send in copies of the documents, do not send originals.

23 General Application Concerns  Fill in EVERY box  Print Clearly  Fill in the Enrollment Site #: DFD576 Place your initials under the blue boxPlace your initials under the blue box  Review the application with the family  Make sure family signs the application  Order more applications and materials

24 Family Worker Responsibilities  Assess families health insurance status  Assist families with completing application when requested  Monitor status of application  Provide follow-up if needed  Report number of applications completed monthly to FWC  Maintain supply of applications

25 FWC Responsibilities  Provide NJ FamilyCare training to new Family Workers  Provide on-going technical assistance for NJ FamilyCare to Family Workers  Report number of NJ FamilyCare applications completed on a quarterly basis to DFD

26 Chain of Events Family Worker Coordinator NJ FamilyCare Vendor Family Worker 2 3 1

27 Follow-Up  Keep a copy of the application and all documents  Allow 2-3 months for eligibility decision  Make yourself accessible to families  Explain the uses for the (800)  Explain Yearly Renewal Process  Encourage families to report changes in: Household – Address – Phone #

28 F.Y.I.  NJ FamilyCare offers Continuous Eligibility for 12 months. This means: If the family’s income increases or family size decreases, it does not have to be reported until it is time to renew. If the family’s income increases or family size decreases, it does not have to be reported until it is time to renew. However, if the family’s income decreases, or family size increases, they should report it right away. It may result in their being placed in a plan with a lower premium or no premium. However, if the family’s income decreases, or family size increases, they should report it right away. It may result in their being placed in a plan with a lower premium or no premium.

29 Applying Online  You can help families fill out the NJ FamilyCare application online at:  You must still follow up with the family, even if they apply online! The online application requires the same documentation as the paper application The online application requires the same documentation as the paper application A confirmation letter will be sent to the applicant requesting the necessary documentation. A confirmation letter will be sent to the applicant requesting the necessary documentation.

30 Case Study After a short break We will do a Sample Case. We will do a Sample Case.

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34 Application Toolkit  Literature  FAQ’s  Documentation Checklist  Immigrant Eligibility Quick Sheet  Hints and Suggestions

35 Questions&Answers

36 NJ FamilyCare Jeopardy Application Details EligibilityRequirementsFollow-up Misc. Questions PenPenPenPen LanyardLanyardLanyardLanyard Tote Bag

37 (800) THANK YOU FOR COMING!