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Gambling with the NJ FamilyCare Waiting Period

I said in my last post about health insurance that I wasn’t too worried about our kids. However, I’m starting to worry a little bit that we’re gambling with the waiting period.  As of April 1, myself and Mr. FireDesired will have basic health insurance, but there’s a gaping hole when it comes to insuring kids via Get Covered NJ and NJ FamilyCare.

Three months uninsured

I found two sites that state that we need to wait 3 months before my kids are eligible for NJ FamilyCare. Three. months. That’s a lot of time to have your kids uninsured.

The NJ FamilyCare Q&A states:

“Is it true that I must be without health insurance for 3 months before I can be eligible for NJ FamilyCare?

Yes, this is true. However, there are exceptions to this rule, such as if you lost your insurance because your place of work went out of business or you were laid off. Depending on income, other exceptions may apply for families privately paying for health insurance or for COBRA benefits. We strongly urge you to call 1-800-701-0710 and speak with a Health Benefits Coordinator to find out if any exceptions apply to you.”

And, the NASHP New Jersey 2019 CHIP Fact Sheet states that if you earn over 200% FPL (and we expect to be over that this year), then there’s a waiting period of 3 months before obtaining coverage under the NJ FamilyCare/CHIP program.

CONSIDERING OTHER OPTIONS

We are still in a global pandemic. NJ’s infection rate is one of the highest in the country. Hospitalizations due to COVID-19 are creeping up state-wide, even with the mass vaccinations. This isn’t a gamble we want to make, but we don’t have a lot of options.

I don’t feel that we’ll ultimately be found ineligible for NJ FamilyCare, given that we meet the income thresholds for low-cost insurance. However, if there was a way to pay for the kids’ insurance at full price for only 3 months, I’d do it.

While waiting for NJ FamilyCare to make a decision about our application, we considered a different option, which was to insure our kids at full price through the Get Covered NJ Marketplace. The following is what is stated in the “Eligibility” section of our Get Covered NJ dashboard:

“The initial evaluation of your application found you or someone in your household to be eligible for Medicaid and your application has been sent to NJ FamilyCare. In almost all cases, NJ FamilyCare will confirm this initial assessment and you will be enrolled in free or low cost Medicaid coverage. You do not need to take any actions now. NJ FamilyCare will be in contact with you about next steps. However, you have the option to enroll in a health plan through GetCoveredNJ at full cost if you have reason to think you will not be found eligible for Medicaid by NJ FamilyCare. If you are enrolled in Medicaid, you will be disenrolled from any GetCoveredNJ health plan you have chosen. You will not get back any premiums you have paid. Select any individual(s) that you would like to enroll in a full cost GetCoveredNJ health plan.”

It sounded like a potential option. We’d pay full price, without any subsidies, to insure our whole family for 3 months. Once our kids eventually get insured via NJ FamilyCare, they would be basically dropped from the Get Covered NJ plan, and we could potentially get our subsidies back.

I couldn’t tell if signing up for full-price insurance via Get Covered NJ would void our eligibility for NJ FamilyCare. So, I started making some phone calls.

Calling NJ FamilyCare (1-800-701-0710 )

With these options and considerations in mind, I called NJ FamilyCare.

Starting with their automated phone service (which was surprisingly decent), I found out the following about my application status:

  1. It’s still being processed.
  2. Further Information is needed before a decision can be made. The system stated that we were sent a letter, which was weird because previous representatives had told us that we would first get a phone call if anything was required of us. (We hadn’t received a phone call yet, but we did receive the aforementioned letter later that day in the mail.)

Again, using their automated phone service, I tried to find more information about our eligibility. However, I think that because a decision has yet to be made, I was automatically put in queue to speak to a representative, which was great. Here’s what I asked her: 

  • Q: Will we have a 3 month waiting period?
    A: It’s not really a 3 month waiting period. Rather, it’s a processing period. Usually, it takes much less time than 3 months.
  • Q: I heard that you have to wait 3 months if you make more than 200% FLP. Is this true?
    A: She didn’t seem to know much about the 200% FPL threshold regarding the waiting time. It really is just the processing time that in most cases takes less than 3 months.
  • Q: Can we insure our kids at full price on Get Covered NJ while we wait up to 3 months for a decision?
    A: Yes, that’s fine, if we want to do that. Our application will continue to get processed.

I felt pretty good after this call. It seemed like getting full coverage for our family, even if it would be expensive, was the right choice to pursue.

Calling Get Covered NJ

Feeling a bit upbeat, I called Get Covered NJ next to find out about changing our coverage to include our kids at full price. Here’s a recap of what I asked and the responses I got:

  • Q: We didn’t initially realize our kids wouldn’t be insured for three months due to the processing time for NJ FamilyCare. Can we get them insured for April 1 if we start the process now and pay full price for them?
    A: No. In order to get the kids covered, we need a NJ FamilyCare date of denial. Without this, the system will reject our kids because they will still consider them CHIP-eligible. If we had the denial of coverage date, all subsidies would be lost in order to insure them with our Get Covered NJ Plan. However, because our application is still being processed at NJ FamilyCare, we can’t get them insurance while we wait through Get Covered NJ. (Sigh… great.)
  • Q:  Is there any way to have them insured during the 3 months it takes to get our application processed with NJ FamilyCare?
    A: No. We need to wait for FamilyCare to be processed to get the date of denial. This is the process that’s in place. There’s nothing we can do but wait.

Obviously, I didn’t feel good anymore about this option. It’s not really an option. There really is a hole when trying to insure kids via Get Covered NJ and NJ FamilyCare.

Calling About CoBRA

So, the fall back is still COBRA. To make sure, Mr. FireDesired called to see if we could insure only our kids through COBRA. Here’s what they talked about:

  • Q: Are there partial family options to just insure kids via COBRA?
    A: Yes.
  • Q: Do we really have 60 days to initiate COBRA and back-date it to April 1?
    A: Yes.
  • Q: What are our options? How much will it cost?
    A: We have to wait until after employment is terminated to find out the specifics.

It turns out that insuring just the kids is a possibility, but we won’t know more details until April.

So we wait

I wrote this post to air out some of my frustrations on this process of getting health insurance for our family. I wish I understood the rationale for the 3-month waiting period because it’s feels like we’re stuck in a cycle where my kids are the ones that get the raw end of the deal. Get Covered NJ determined that my kids were not eligible to enroll in a plan on the Marketplace and initiated our application to NJ FamilyCare.  NJ FamilyCare takes up to 3 months to process our application. Even though they expect that it will take less time than that, my kids will be uninsured. We can’t even insure them at full price in the marketplace while we wait. It’s a messed-up process.

Most likely, our kids will be fine, and we won’t need the insurance. But, we don’t buy insurance with the hopes of using it. It’s for peace of mind.

Thank goodness COBRA is there as a fall back. We only have 60 days to sign up and back date the insurance to April 1 for the kids. If it looks like NJ FamilyCare is still working on processing our application by the end of May, we will most likely sign up for COBRA just for the kids. We’ll have to wait until next month to get the specifics.

Additional Note

A few hours after I published this post, I watched a press conference for a new Cover All Kids Proposal to make insuring kids easier and less burdensome for those of us living in NJ. They mention removing the NJ FamilyCare 90-day waiting period, which I think many folks would welcome. I’m glad they’re looking to do this for the future. Pandemic or not, it doesn’t make sense to require up to 90 days of being uninsured before getting access to health insurance.

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