New Jersey expands Special Enrollment Period for those losing Medicaid/CHIP

via the NJ Dept. of Banking & Insurance:

New Jersey Department of Banking and Insurance Acting Commissioner Justin Zimmerman today announced an expanded Special Enrollment Period for individuals who are no longer eligible for NJ FamilyCare and qualify for health insurance through Get Covered New Jersey, the state’s Official Health Insurance Marketplace. The expanded Special Enrollment Period will be available to anyone who lost NJ FamilyCare coverage due to resumption of eligibility reviews regardless of the date they lost coverage. Previously, individuals had 120 days to enroll after their NJ FamilyCare coverage ended.

As required by federal law, the Department of Human Services restarted eligibility reviews for NJ FamilyCare on April 1, 2023. Those who no longer qualify for NJ FamilyCare because their income is too high may be eligible to obtain health coverage through Get Covered New Jersey and may be able to get help paying for premiums.

“Today’s action is another example of the Murphy Administration’s commitment to ensure residents have access to the health coverage they need and deserve,” said Acting Commissioner Zimmerman. “This expanded Special Enrollment Period will provide greater opportunity for individuals who have been found ineligible for NJ FamilyCare throughout the Medicaid renewal process to enroll in health insurance through Get Covered New Jersey. Given the number of individuals affected and the need for them to make informed decisions about their coverage options, allowing additional time to enroll in a health plan will be beneficial for consumers.”

All qualified individuals who lose NJ FamilyCare coverage between March 31, 2023 and July 31, 2024 who submit a new application or update an existing application for coverage through Get Covered New Jersey and attest that they have lost coverage between the same time period, are eligible for the expanded Special Enrollment Period (SEP).  Consumers are not required to submit documentation for this qualifying life event to receive the SEP.

“Everyone should have access to affordable and high-quality health care coverage, and we also want everyone to avoid any gap in their coverage,” Human Services Commissioner Sarah Adelman said. “Continuity of care is a priority, which is why I thank Acting Commissioner Zimmerman for taking this vital step. We continue to urge NJ FamilyCare members who have not already done so to update their contact information and to respond as soon as possible to mail from the state or their county board of social services so you can stay covered.”

The Department of Human Services continues to urge NJ FamilyCare members to confirm or update their contact information by calling NJ FamilyCare at 1-800-701-0710 (TTY: 711). Consumers should make sure they promptly respond to any mail from NJ FamilyCare to receive an updated eligibility determination. 

Consumers who are determined ineligible by NJ FamilyCare based on their income, will be automatically transferred to GetCoveredNJ and will receive a welcome notice by mail or email with a unique access code from GetCoveredNJ that allows them to access their account, find out if they qualify for financial help and enroll in health insurance. Consumers who lose NJ FamilyCare coverage as a result of not completing their renewal form will not have their information transferred to GetCoveredNJ, but can enroll in coverage through GetCoveredNJ if eligible.​ Some consumers who are no longer eligible for NJ FamilyCare may be eligible for health insurance from an employer or may now be eligible for Medicare.

Get Covered New Jersey is where individuals and families can easily shop for and buy health coverage and it is the only place to receive financial help. Get Covered New Jersey is a source of affordable health insurance for New Jersey residents who do not have health coverage from their employers or access to other health care programs. Nine out of 10 enrollees will qualify for financial help. Due to the substantial savings from the federal government and the State of New Jersey, many individuals will have access to a health plan at a cost of $10 a month or less in 2024.

Typically, the Get Covered New Jersey Open Enrollment Period, November 1 to January 31, is the only time residents without health insurance through an employer, or other program such as NJ FamilyCare or Medicare, can enroll in coverage unless they have a qualifying life event or meet certain income levels. Residents at certain income levels (up to $29,160 for an individual or $60,000 for a family of four for 2024) are eligible for nearly free coverage year-round through the Expanded Access Special Enrollment Period.

To avoid duplicate coverage and potential tax implications, consumers should apply for coverage through GetCoveredNJ after they have received notification from NJ FamilyCare that they are no longer eligible for NJ FamilyCare coverage. Once consumers receive confirmation that their coverage will not be renewed, residents can find free local assistance on the Get Covered New Jersey website, and browse plans and see if they qualify for financial help with the Shop and Compare Tool.

All plans sold through Get Covered New Jersey (GetCovered.NJ.gov) meet the high standards of the Affordable Care Act. While individuals are searching for new coverage options, the department advises them to be aware of plans with limited coverage that – unlike the health plans available at Get Covered New Jersey – do not cover basic services and pre-existing conditions. People who purchase these types of plans may only realize they are not comprehensive when they are denied coverage for a medical necessity. It should also be noted that short-term limited duration plans, sometimes referred to as junk plans, are prohibited in New Jersey. Health insurance plans available through Get Covered New Jersey offer comprehensive coverage and consumers cannot be denied due to a pre-existing condition.

For more information about Get Covered New Jersey, visit our Frequently Asked Questions (Loss of NJ FamilyCare) at GetCovered.NJ.gov

For more information about NJ FamilyCare eligibility reviews visit here.

To read the bulletin, go to: Bulletin No. 24-03