Medicaid, SCHIP, and Federal Authority⁴

Section 1115 Waiver - In 2001, the state received approval from CMS to implement a waiver demonstration that extended coverage to parents of Medicaid or SCHIP eligible children with incomes up to 200 percent FPL and pregnant women with incomes between 185 percent and 200 percent FPL. Under this waiver, Medicaid covered parents with incomes up to 133 percent FPL and SCHIP covered parents between 134 percent and 200 percent FPL. Although parent enrollment was capped as of June 14, 2002, parent enrollment up to 100 percent FPL was initiated again on September 1, 2005. This increased to 115 percent FPL on September 1, 2006, and will further increase to 133 percent FPL on September 1, 2007.

HIFA Demonstration Waiver - In 2003, New Jersey received approval from CMS to modify the SCHIP 1115 waiver.  The waiver modification standardized coverage to uninsured parents and relative caretakers of children in the Medicaid and SCHIP programs whose incomes are at or below 133 percent FPL to that of the parents between 134 percent and 200 percent FPL, which was a standard commercial benefit package.

Limited-Benefit Plan  

In 2002, the New Jersey legislature passed legislation which required individual market carriers to offer a limited-benefit plan, called Basic and Essential Health Care Services Plan (B&E). The B&E plan provides for 90 days of hospitalizations, limited wellness and practitioner visit benefits, and some other limited benefits. The plan does not include some benefits typically covered by commercial plans such as chemotherapy, outpatient drugs, prenatal care, speech and occupational therapy, home health, or hospice services.

Carriers are able to use modified community rating for B&E plans; however, all other products in New Jersey are pure community rated. As of 2Q06, there were over 16,000 members enrolled in the B&E plan.

Dependent Coverage

At the option of the insured person, a dependent may be covered up to their 30th birthday, as long as they have no dependents of their own.  The insurance provider may charge a higher rate for this coverage, but the increase is not to exceed 3 percent of the premiums. (Public Act 2005 c.375)

Other  

Family Care Coverage - New Jersey 's FamilyCare program originally enrolled childless adults up to 100 percent FPL with state-only funds. Enrollment was capped as of September 1, 2001. Currently only those with income at 23 percent FPL may be eligible for coverage.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

⁴ The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

⁵ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.