New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 79 - NJ FAMILYCARE-CHILDREN'S PROGRAM
Subchapter 6 - BENEFICIARY RIGHTS AND RESPONSIBILITIES
Section 10:79-6.8 - Limitation on cost sharing-Plans C and D

Universal Citation: NJ Admin Code 10:79-6.8

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

(a) There shall be a family limit on the level of cost-sharing equal to five percent of gross household income for Plan C and D beneficiaries. Cost-sharing shall include the premium payments and the personal contribution to care.

(b) The cost-sharing limit shall be calculated annually starting with the date of initial enrollment of any children in the family or the annual reenrollment date. For ease of administration, the annual premium shall be calculated by the Statewide eligibility determination agency and used to reduce the family cost from the first day of enrollment.

(c) Once the limits have been met, the Statewide eligibility determination agency shall issue a certification indicating that the Plan C or D member has met their cost share limit, and the provider shall not collect a personal contribution until further notice.

(d) No cost sharing shall be imposed on children who are American Indians/Alaska Natives. Proof of Federally recognized AI/AN tribal status shall be in the form of a tribal card or letter, in accordance with 42 C.F.R. 36a.16.

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