New Jersey-2024-A5011-Introduced

An Act concerning NJ FamilyCare eligibility for certain children.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. As used in this act:

"Child with special needs" means a child under the age of 21 years who is blind or disabled, as defined in section 1614(a)(3)(C) of Title XVI of the federal "Social Security Act," (42 U.S.C. 1382c).

NJ FamilyCare" means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children's Health Insurance Program.

2. a. The Commissioner of Human Services shall establish a three year pilot program to provide NJ Family Care benefits for a child with special needs who lives in the family home and, except for parental income or resources, would otherwise qualify for benefits under the federal Supplemental Security Income program, established pursuant to Title XVI of the federal "Social Security Act," (42 U.S.C. 1381 et seq.).

b. (1) On an annual basis, the Department of Human Services shall redetermine whether a child with special needs continues to meet the definition of blind or disabled for the purposes of the federal Supplemental Security Income program, as provided in section 1614(a)(3)(C) of Title XVI of the federal "Social Security Act," (42 U.S.C. 1382c).

(2) If, as a result of the redetermination process provided in paragraph (1) of this subsection, the department determines that the child no longer qualifies as blind or disabled for the purposes of the federal Supplemental Security Income program, the department shall terminate NJ FamilyCare benefits for the child.

(3) The commissioner shall establish a process by which the parent or legal guardian of a child with special needs can appeal the termination of NJ FamilyCare benefits resulting from a redetermination conducted pursuant to paragraph (1) of this subsection.

3. Within 180 days of the conclusion of the pilot program established pursuant to section 2 of this act, the Commissioner of Human Services shall report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), on the number of children with special needs who became newly eligible for NJ FamilyCare benefits pursuant to section 2 of this act, the total cost of the NJ FamilyCare benefits provided to these children, and the department's costs to administer the pilot program. The report shall also include the commissioner's recommendations on whether the State should make the NJ FamilyCare benefits, available under the pilot program, permanent for children with special needs.

4. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

5. The Commissioner of Human Services shall adopt rules and regulations pursuant to the "Administrative Procedure Act" P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this act.

6. This act shall take effect immediately and shall expire upon the submission of the report pursuant to section 3 of this act.

STATEMENT

The bill requires the Commissioner of Human Services (the commissioner) to establish a three year pilot program to provide NJ FamilyCare benefits to children with special needs who live in the family home and, except for parental income and assets, would qualify for federal Supplemental Security Income (SSI) benefits. The bill defines a "child with special needs" as a child under the age of 21 who meets the federal definition of blind or disabled for the purposes of the SSI program, as provided in section 1614(a)(3)(C) of Title XVI of the federal "Social Security Act," (42 U.S.C. 1382c).

The Department of Human Services (department) will annually redetermine whether a child with special needs continues to meet the definition of blind or disabled under the SSI program. If the department determines that the child no longer qualifies as blind or disabled for the purposes of the SSI program, the department will terminate the child's NJ FamilyCare benefits. The commissioner will establish an appeals process for families whose child's NJ FamilyCare benefits were terminated subsequent to a redetermination.

Within 180 days of the end of the pilot program, the commissioner will report to the Governor and to the Legislature on:

1. the number of children with special needs who became eligible for NJ FamilyCare benefits under the initiative;

2. State costs to provide NJ FamilyCare benefits under the pilot program;

3. the department's costs to administer the pilot program; and

4. the commissioner's recommendations concerning continuation of the benefits available under the initiative.

The pilot program will expire upon submission of the report to the Governor and the Legislature.

Federal SSI benefits, which include monthly income support and access to State Medicaid benefits, are available to children under the age of 18, or children under the age of 22 who are students regularly attending school, and who meet the SSI program's definition of blind or disabled. Federal SSI benefits are only available to special needs children whose parents or legal guardian have limited income and assets.

Under the State's comprehensive Medicaid demonstration waiver, children whose medical condition necessitates a nursing home level of care can access private duty nursing services through the Medicaid Long-Term Supports and Services program (MLTSS), regardless of parental income or assets. Many middle-income families of children whose disabilities do not require nursing-home level of care, and who do not qualify for NJ FamilyCare or SSI benefits due to income or assets, struggle to afford the care and services necessary for their children to continue to live in the family home. It is the sponsor's intent to provide, even on a pilot basis, NJ FamilyCare benefits to alleviate the financial burden placed on middle-income families who have children with special needs.