Health Care Enrollment and NJ Paid Family Leave
About Affordable Health Care and NJ Paid Family Leave
Health Care Enrollment
Since March of 2020, NJ FamilyCare/Medicaid has followed special rules related to the federal COVID-19 Public Health Emergency (PHE). These rules have allowed most NJ FamilyCare/Medicaid members to keep their health coverage, even if they no longer qualified – for example, if their income was too high.
There are new Medicaid rules that began on April 1, 2023 and NJ FamilyCare will begin its eligibility determination process. It is estimated that over 350,000 people may be losing coverage.
States have 12 months after the April 1, 2023 re-start date to initiate eligibility renewals for all Medicaid beneficiaries, including more than 2 million NJ FamilyCare members. There are also new rules from Congress about eligibility and outreach. This “unwinding” represents the single largest renewal exercise in the history of New Jersey’s Medicaid program.
This means that:
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- All members enrolled in an NJ FamilyCare program will be reviewed to see if they still qualify for coverage.
- Many members will receive mail from the State of New Jersey or their County Board of Social Services as part of the review.
- Members will have to confirm or provide additional nformation so NJ FamilyCare/Medicaid can decide whether they still qualify for healthcare coverage.
- Members who do not respond to NJ FamilyCare/Medicaid mail may lose their coverage.
Important steps to take now include:
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- Confirm or update your contact information by calling NJ FamilyCare at 1-800-701-0710 (TTY: 711)
- Look for and respond to mail from the State of New Jersey or the local County Board of Social Services.
- If NJ FamilyCare requests information, respond right away to avoid a gap in NJ FamilyCare coverage.
Note: People who no longer qualify for NJ FamilyCare may be able to get Health coverage through GetCoveredNJ, the state’s official health insurance marketplace.
GetCoveredNJ offers immediate eligibility results and lets people know if they can get help lowering the cost of their monthly premiums.
Affordable Care Act Coverage
NJ has its own online health insurance Marketplace where NJ residents under age 65 can shop for and apply for a health plan and find out what financial assistance they may be eligible for.
- Open Enrollment is November 1st 2022 to January 31st 2023
- Special Enrollment is available from Feb – October 2023 for those who have a qualifying event, such as a birth, change in marital status, being disqualified for Medicaid and others.
- Financial assistance is available for those who qualify and 9 in 10 enrollees receive financial assistance.
This year, net premiums will be lower than ever before – Many households will qualify for nearly free premium coverage.
There are 3 ways to enroll:
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- Online at GetCovered.NJ.gov
- By Phone at (888) 654-3893
- In Person
Free Enrollment Assistance is available. New Jersey Citizen Action offers enrollment assistance.
Call to speak to an enrollment assister at: (888) 654-3893
Schedule an appointment for Enrollment Assistance by emailing NJ Citizen Action at GetCovered@NJCitizenAction.org
Cover All Kids: NJ FamilyCare Coverage for all Income-Eligible Children under Age 19
Beginning January 1, 2023, all income-eligible children under the age of 19 – regardless of immigration status – became eligible to enroll in NJ FamilyCare health insurance program.
NJ FamilyCare is a publicly funded health insurance program that includes Medicaid and the Children’s Health Insurance Program (CHIP). It is managed by the NJ Department of Human Services. Undocumented children are eligible if the family earns no more than 355% of the federal poverty level, which equates to $8,210 a month for a family of four.
This expanded eligibility is expected to apply to 16,000 children in NJ. It will allow children to:
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- get health care insurance for the first time, andnsee a pediatrician or
- visit an emergency room without their families wondering how to pay the bill.
Learn more and apply here or call 1-800-701-0710 (TTY: 711).
Individuals ineligible for NJ FamilyCare can find information on other insurance affordability programs at www.getcovered.nj.gov
NJ Paid Family Leave Insurance
New Jersey has had a state paid family leave program since 2009 and it was expanded in 2019. Workers can use NJ Family Leave Insurance (FLI) when they need to take leave for:
Bonding
Both parents can take FLI to bond with a new child in the first year after birth, placement, or adoption.
CARING FOR A LOVED ONE
Workers can take FLI to care for family or loved one who has a physical or mental health condition. A loved one is any family member or individual who is considered to be family. A health care provider certifies their health condition.
COPING /W DOMESTIC OR SEXUAL VIOLENCE
Workers (and those caring for a loved who is a victim/survivor) can take FLI to seek medical attention, therapy, victim advocacy, legal services, recovering at home, seeking safe shelter, among other things.
Family Leave Insurance is available to most employees working in NJ.
Exemptions are:
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- Federal government employees out-of-state employees workers that are not technically employees (such as contractors).
Family Leave Insurance is available to most employees working in NJ.
Exemptions are:
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- Federal government employees out-of-state employees workers that are not technically
- Employees (such as contractors).
To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in the base year. You must have a valid SS# A standard base year is the first 4 of the last completed 5 quarters (when employers report wages) before taking leave.
Benefits are paid at 85% of a worker’s average weekly wage with a maximum weekly benefit of $1,055 in 2024. Available for up to 12 consecutive weeks or 56 days or 8 weeks if taken intermittently.
Other Helpful Resources
In partnership with NJ Citizen Action, SPAN conducts outreach, education, training and train-the-trainer workshops on worker benefits and protections, including NJ Paid Family and Medical Leave benefits, Earned Sick Leave, and Unemployment Insurance.
Contact
Rhea Malone, rmalone@spanadvocacy.org
Paid Leave and ACA Ambassaor
Danica LaFortune, dfortune@spanadvoacy.org,
Paid Leave and ACA Ambassador