New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 8 - ENROLLEES
Section 10:74-8.3 - Voluntary managed care enrollment (allowed and not allowed)

Universal Citation: NJ Admin Code 10:74-8.3

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

(a) The following individuals shall be excluded from the automatic assignment process but may enroll voluntarily:

1. Individuals whose Medicaid or NJ FamilyCare-Plan A eligibility will terminate within three months or less after the projected date of effective enrollment;

2. Individuals in mandatory eligibility categories who live in a county where mandatory enrollment is not yet required based on a phase-in schedule determined by DMAHS;

3. Individuals already enrolled in, or covered by, either a Medicare or commercial MCO, shall not be enrolled in a contractor's plan, unless the contractor and the Medicare or commercial MCO are the same;

4. Individuals in the Medicaid Pharmacy Lock-in, Provider Warning, or Hospice programs (see "Special Status" requirements at 10:49-14.2, and general hospice requirements at N.J.A.C. 10:53A);

5. Individuals in Medicaid eligibility categories other than those specified in 10:74-8.1;

6. Individuals eligible through Child Protection and Permanency (CP&P) who are not in resource family care:
i. All individuals eligible through CP&P shall be considered a unique case and shall be issued an individual 12-digit identification number and shall be enrolled in his or her own right.

7. Children awaiting adoption through a private agency;

8. Individuals identified as having more than one active eligible Medicaid/NJ FamilyCare number; and

9. Dual Medicare/Medicaid eligibles.

(b) NJ FamilyCare applicants shall be exempt from automatic assignment, but they are not covered for medical services until they select and enroll in a managed care plan.

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