Bill Text: NJ A5273 | 2022-2023 | Regular Session | Amended

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Bill Title: Requires automatic enrollment of certain persons recently ineligible for Medicaid in health benefits plan; requires DHS to electronically publish certain data regarding NJ FamilyCare eligibility renewals and call center performance.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2023-06-05 - Reported out of Asm. Comm. with Amendments, and Referred to Assembly Appropriations Committee [A5273 Detail]

Download: New_Jersey-2022-A5273-Amended.html

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[First Reprint]

ASSEMBLY, No. 5273

STATE OF NEW JERSEY

220th LEGISLATURE

 

INTRODUCED FEBRUARY 28, 2023

 

 

Sponsored by:

Assemblyman  DANIEL R. BENSON

District 14 (Mercer and Middlesex)

Assemblyman  STERLEY S. STANLEY

District 18 (Middlesex)

 

 

 

 

SYNOPSIS

     Requires automatic enrollment of certain persons recently ineligible for Medicaid in health benefits plan; requires DHS to electronically publish certain data regarding NJ FamilyCare eligibility renewals and call center performance.

 

CURRENT VERSION OF TEXT

     As reported by the Assembly Financial Institutions and Insurance Committee on June 5, 2023, with amendments.

  

An Act concerning automatic enrollment of certain individuals in health insurance and public access to certain NJ FamilyCare data, supplementing P.L.2019, c.141 (C.17B:27A-57 et seq.) and P.L.1968, c.43 (C.30:4D-1 et seq.), and amending P.L.2019, c.357.

 

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

 

     1.    ¹(New section)¹  a.  Notwithstanding the provisions of any law, rule, or regulation to the contrary, the Department of Human Services shall provide to the Department of Banking and Insurance any information concerning any individual who:

     (1)   becomes ineligible for medical assistance through the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) because the individual no longer meets the income requirements of the program; and

     (2)   does not have access to a health benefits plan available through the individual's employer or as the dependent of an individual who has access to a health benefits plan available through the individual's employer.

     b.    The information shall be provided:

     (1)   as shall be necessary to implement the provisions of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), as determined by the Department of Banking and Insurance in consultation with the Department of Human Services; and

     (2)   to the Department of Banking and Insurance at the time the individual becomes ineligible for medical assistance.

     c.     The provisions of P.L.    , c.    (C.        ) (pending before the Legislature as this bill) shall not apply to an individual determined pursuant to this section to have access to a health benefits plan available through the individual's employer or as the dependent of an individual who has access to a health benefits plan available through the individual's employer.

 

     2.    ¹(New section)¹  a.  Upon receipt of the information provided pursuant to section 1 of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), the Commissioner of Banking and Insurance shall use the available information to enroll the individual ¹[or individuals]¹ in:

     (1)   for ¹[individuals] an individual¹ with an annual household income of not more than 200 percent of the federal poverty level, the lowest cost silver-level plan available through the State-based exchange, established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.) ¹,¹ that does not qualify as a high deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223); and

     (2)   for ¹[individuals] an individual¹ with an annual household income of more than 200 percent of the federal poverty level, the lowest cost plan at the best actuarial value available through the State-based exchange, established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.) ¹,¹ that does not qualify as a high deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223).

     b.    Plan enrollment shall occur before the termination date of coverage through the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

     c.     The plan's premium due date shall be no sooner than the last day of the first month of enrollment in the plan.

     d.    The Commissioner of Banking and Insurance shall provide an individual who is enrolled in a plan pursuant to this section with a notice, which shall include the following information:

     (1)   the plan in which the individual is enrolled;

     (2)   the individual's right to select another available plan and any relevant deadlines for that selection;

     (3)   how to receive assistance to select a plan;

     (4)   the individual's right not to enroll in the plan;

     (5)   information for an individual appealing the individual's previous coverage through an insurance affordability program; and

     (6)   a statement explaining:

     (a)   if there is a premium due, that the plan will only go into effect, and services received during the first month of enrollment will only be covered by the plan, if the individual pays the premium by the due date;

     (b)   if there is no premium due, that the plan will go into effect and provide coverage unless the individual chooses not ¹[the] to¹ enroll in the plan;

     (c)   that additional monthly payments may be required to maintain coverage under the plan; and

     (d)   the plan's monthly premium, the amount of subsidies for which the individual qualifies, and the total monthly payment for which the individual will be responsible.

     e.     The Department of Banking and Insurance shall adopt, in consultation with the Department of Human Services, rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of P.L.    , c.    (C.        ) (pending before the Legislature as this bill).

 

     3.    Section 1 of P.L.2019, c.357 (C.17B:27A-6.1) is amended to read as follows:

     1.    Notwithstanding the provisions of any other law, rule or regulation to the contrary, the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10) shall establish, by regulation, an annual open enrollment period during which time individuals are permitted to enroll in an individual health benefits plan and individuals who already have coverage may replace current coverage.  During any plan year in which the State is on the federally-facilitated exchange, the annual open enrollment period shall conform to federal requirements, unless the State is permitted to offer a longer open enrollment period.  During any plan year in which the State operates a State-based exchange, the open enrollment period shall be set by New Jersey's State-based exchange and shall not be less than 90 days.

     The commissioner shall have the authority to establish a special enrollment period for any automated coverage assignment ¹made¹ pursuant to section 2 of P.L.    , c.    (C.        ) (pending before the Legislature as this bill) or any other law, as determined by the commissioner.

(cf: P.L.2019, c.357, s.1)

 

     4.    ¹(New section)¹  a.  The Division of Medical Assistance and Health Services in the Department of Human Services shall provide the following information on the NJ FamilyCare Data Dashboard website, or any public facing web-based dashboard that provides key demographic and performance metrics regarding the NJ FamilyCare Program that replaces the NJ FamilyCare Data Dashboard website:

     (1)   the number of eligibility renewals each month;

     (2)   the number of eligibility renewals processed each month that did not require an enrollee to respond to renewal documents;

     (3)   the number of eligibility renewals each month that required an enrollee to respond to renewal documents;

     (4)   the number of eligibility terminations each month;

     (5)   the number of eligibility terminations each month that were due to the ¹[department's failure to receive documents or information needed to make an eligibility determination and requested from an enrollee] department not receiving documents or information requested from an enrollee, or that were due to the department receiving incomplete documents or information requested from an enrollee, which documents or information were needed to make an eligibility determination¹ ;

     (6)   the average wait time each month for callers to NJ FamilyCare call centers to speak with a representative;

     (7)   the number of phone calls received each month by NJ FamilyCare call centers Statewide;

     (8)   the number of phone calls received each month by NJ FamilyCare call centers Statewide in which the caller speaks with a center representative; and

     (9)   the number of phone calls received each month by NJ FamilyCare call centers Statewide in which the caller abandons the call before speaking with a center representative.

     b.    The data provided on the NJ FamilyCare Data Dashboard website, or any subsequent dashboard, pursuant to paragraphs (1), (2), (3), (4), and (5) of subsection a. of this section shall be grouped according to the following:

     (1)   race;

     (2)   NJ FamilyCare eligibility group, which shall include Modified Adjusted Gross Income-based children, Modified Adjusted Gross Income-based adults, beneficiaries who qualify based on disability, and beneficiaries who qualify based on age and who are 65 years of age or older; and

     (3)   age, which shall include the following ranges:  enrollees age 18 years and younger; enrollees age 19 through 64 years; and enrollees age 65 years and older.

 

     5.    This act shall take effect on the 90th day next following enactment.