New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 8 - ENROLLEES
Section 10:74-8.1 - Mandatory managed care enrollment

Universal Citation: NJ Admin Code 10:74-8.1

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Medicaid eligible persons and NJ FamilyCare-Plan A children who reside in geographically defined enrollment areas designated for mandatory enrollment and who are not institutionalized, excluded or exempt, and who belong to one of the eligibility categories listed at (b) below shall enroll in an MCO of their choice, or, if a choice is not made, an MCO shall be assigned for them.

(b) The following Medicaid/NJ FamilyCare-Plan A eligibility groups shall enroll in a managed care organization:

1. Medicaid Special (covers children ages 19 to 21, using AFDC standards);

2. Pregnant women and infants up to age one with incomes at or below 185 percent of the Federal Poverty Level who are eligible under New Jersey Care . . . Special Medicaid Programs;

3. Families who are eligible for Medicaid using the Aid to Families with Dependent Children (AFDC)-Related Medicaid rules at N.J.A.C. 10:69;

4. SSI aged, blind, and disabled, and essential spouses;

5. Aged, blind, and disabled eligible under New Jersey Care . . . Special Medicaid Programs;

6. Division of Developmental Disabilities clients, including those covered under the Division of Developmental Disabilities Community Care Waiver;

7. Medicaid only or SSI-related aged, blind or disabled eligible beneficiaries;

8. Uninsured children up to the age of 19 who qualify for the NJ FamilyCare-Plan A program; and

9. Children under CP&P supervision in resource family care.

(c) All other NJ FamilyCare (non-Plan A) applicants shall select and enroll in an MCO in order to receive medical coverage. A selection of an MCO shall not be made for NJ FamilyCare non-Plan A applicants. Until they select an MCO, they shall not be covered for any medical benefits.

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