New Jersey Changes FamilyCare Income Requirements to Reduce Eligibility Levels for Childless Adults

Starting Sept. 1, New Jersey's FamilyCare program will adopt new eligibility rules to reduce the income limit for childless adults in the hopes of enrolling more children and their parents, the Bergen Record reports (Parello, Bergen Record, 8/16). FamilyCare is a non-Medicaid CHIP expansion program that currently covers children from low-income families, their parents and some childless adults. Since it began last October, FamilyCare has enrolled 121,000 adults -- "outpacing" its goal of 125,000 adult enrollees by 2003 -- but has attracted only 5,000 new children (Kaiser Daily Health Policy Report, 8/10). To reverse this trend, state officials on Aug. 15 announced new eligibility requirements that will make about 9,000 currently eligible childless adults ineligible for FamilyCare coverage. Currently, the program covers single adults earning up to $8,590 and childless couples up to $11,610. Under the new rules, income limits will be capped at $2,600 for singles and $3,640 for childless couples. The Record reports that the 13,000 childless adults enrolled in the program under the current requirements will be permitted to keep their insurance. In addition to changing the income requirements, the state also lengthened the waiting period before coverage takes effect. Currently, beneficiaries are eligible to receive care after completing the enrollment process but before enrolling in an HMO. The new rules require enrollees to be in an HMO before their coverage becomes effective, which may take "months." Acting Human Services Chief James Smith said, "The actions ... will strengthen our ability to continue to enroll children and their parents in the program in the months ahead."

Marketing Efforts Criticized
In announcing the eligibility changes, Smith also said the state is launching a $1.5 million marketing effort to increase enrollment among families of four earning between $35,300 to $61,775 annually, or between 200% and 350% FPL. The Record reports that some state lawmakers have criticized the new rules, saying the change was made because of "budget considerations" rather than resident need. State Sen. Joseph Vitale (D) said, "Despite the [Human Service] department's rhetoric, what this decision amounts to is denying coverage for low-income adults." Cece Lentini, a spokesperson for the state Department of Human Services, said the change was made in keeping with the program's original goal of covering more children. "The primary focus of this program is children. And we believe there are a lot more children out there that are eligible," she said. "It's possible additional changes will be made down the road. We do not know if we will continue to enroll people on an unlimited basis," she added (Bergen Record, 8/16). For further information on state health policy in New Jersey, visit State Health Facts Online.