Medicaid and CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. In order to participate in Medicaid, Federal law requires states to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups.

States establish and administer their own Medicaid programs, and determine the type, amount, duration, and scope of services within broad federal guidelines. States are required to cover certain “mandatory benefits,” and can choose to provide other “optional benefits” including prescription drugs. States receive federal matching funds to provide these benefits.

Cost Sharing
States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges.

The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a distinct purpose, and distinct requirements. This information is changing as a result of the approval by CMS of a new Comprehensive Waiver for New Jersey in October of 2012. DHS will be posting updates and changes on their website as information is available.

1915(c) Home & Community-Based Waivers
The 1915(c) waivers are one of many options available to states to allow the provision of long term care services in home and community based settings under the Medicaid Program. States can offer a variety of services under an HCBS Waiver program. Programs can provide a combination of standard medical services and non-medical services. Standard services include but are not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

Long-Term Services & Supports
The Medicaid program allows for the coverage of Long Term Care Services through several vehicles and over a continuum of settings. This includes Institutional Care and Home and Community Based Services (HCBS).

Delivery Systems
Medicaid and CHIP refers to the combination providers, institutional setting, and health care benefit resources as a "delivery system". States have choices in their approach to delivery system design under the Medicaid and CHIP programs. Historically and by statute, the standard delivery system for Medicaid is fee for service but states (including New Jersey) are increasingly moving to the use of managed care and other integrated care models. There are also other innovative and flexible options available to states including Self Direction and Telemedicine.

Quality of Care
Medicaid and the Children’s Health Insurance Program’s goal is to provide safe, effective, efficient, patient-centered, high quality and equitable care to all enrollees. To achieve these goals, the Centers for Medicare & Medicaid Services (CMS) partners with states to share best practices and to provide technical assistance to improve the quality of care.

Financing & Reimbursement
Medicaid is jointly funded by the Federal government and the states. The Federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).

Data & Systems is a major resource for information on Medicaid systems, coding information and data.

Outreach & Enrollment
The Center for Medicaid and CHIP Services (CMCS) works with states to identify and enroll people who are eligible for Medicaid or the Children’s Health Insurance Program but who are not enrolled.

Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but can’t afford private coverage. Signed into law in 1997, CHIP provides Federal matching funds to States to provide this coverage.

 NJ FamilyCare

NJ Family Care is not a welfare program, but rather the State of New Jersey's way of providing affordable health coverage for kids and certain low-income parents/guardians. NJ FamilyCare is a federal and state funded health insurance program created to help New Jersey's uninsured children and certain low-income parents and guardians to have affordable health coverage. It is not a welfare program. NJ FamilyCare is for families who do not have available or affordable employer insurance, and cannot afford to pay the high cost of private health insurance.

The entire application process can be completed by mail or online.
NJ FamilyCare
Affordable Health Coverage. Quality Care.

500 Horizon Drive, Suite 530 Robbinsville, NJ 08691
Phone: 609.588.8200; 800.4.AUTISM | Fax: 609.588.8858