1 (800) 701-0710 tty 1-800-701-0720 (for hearing impaired individuals)

11

www.njfamilycare.org

(800) 701-0710TTY 1-800-701-0720(For hearing impaired individuals)

22

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

33

Impact on CommunitiesImpact on Communities

High hospitalization ratesHigh hospitalization rates

Overcrowded Emergency RoomsOvercrowded Emergency Rooms

44

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.

55

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

66

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*)

77

*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

88

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)

99

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.

1010

Continuum of CareContinuum of Care

Healthy ChildrenHealthy ChildrenHealthy ParentsHealthy Parents

Healthy FamiliesHealthy Families

=

=

=

1111

Year 2006 Income Guidelines*

Maximum Annual/Monthly

Income

Family Size One Child

Family Size 2 people






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

1212

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…

1313

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

Maximum Annual/Monthly

Income

Family Size One Child














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

1414

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

1515

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

1616

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

1717

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.

1818

The ApplicationThe Application

1919

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

2121

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

2222

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.

2323

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

2424

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

2525

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

2626

Chain of EventsChain of Events

Family Worker CoordinatorFamily Worker CoordinatorFamily WorkerFamily Worker

NJ FamilyCare VendorNJ FamilyCare Vendor

2

3

1

2727

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 #

2828

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.

2929

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.

3030

Case StudyCase Study

After a short breakAfter a short break

We will do a Sample Case .We will do a Sample Case .

3434

Application ToolkitApplication Toolkit LiteratureLiterature

FAQ’sFAQ’s

Documentation ChecklistDocumentation Checklist

Immigrant Eligibility Quick SheetImmigrant Eligibility Quick Sheet

Hints and SuggestionsHints and Suggestions

3535

Questions Questions

& &

AnswersAnswers

3636

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

3737

www.njfamilycare.org

(800) 701-0710

THANK YOU FOR COMING!