If you are now receiving health care through the NJ FamilyCare program, there have been changes to the program that may affect your benefits. If you have any questions about these changes or questions about a notice you may have received from NJ FamilyCare that needs your attention, you may call Legal Services of New Jersey’s toll-free hotline at 1-888-576-5529 and ask to speak to the Health Care Access Project attorney. Following are some of the more frequently asked questions about these changes.

I am currently covered under either Plan A or Plan D. What will happen to my benefits?

If you are in Plan A, there have been no changes to your coverage as long as you still meet the eligibility requirements. If you are a restricted alien in Plan D, as of November 1, 2003, you were moved to Plan H. Your benefits under Plan H will be less than what you had before. Plan H will no longer cover hospice, optometrist services, vision care and eyeglasses, podiatrist services, outpatient rehabilitation, family planning, prosthetic appliances, organ transplant services, or private duty nursing. You will have to choose a new HMO from Horizon Mercy, University Health Plans, or AmeriChoice, the only three Medicaid HMOs participating in this plan. If you have any questions about what is covered under Plan H, please call the hotline number listed above or NJ FamilyCare at 1-800-701-0710.

I was in Plan H, or I was switched to Plan H. Will I have to do anything to keep my benefits?

As of November 1, 2003, you will still be eligible for NJ FamilyCare as long as you still qualify, but you will have to pick a new HMO from one of the three Medicaid HMOs that participate in NJ FamilyCare coverage. These are Horizon Mercy, University Health Plans, or AmeriChoice. No other HMO will be participating in NJ FamilyCare Plan H. All members of your family must be in the same HMO.

If you are not already in one of these three HMOs, you should have completed a dis-enrollment form and the HMO Plan Selection form. Both of these forms should have been completed, signed, and returned to the NJ FamilyCare Health Benefits Coordinator by October 9, 2003. If you did not already comply, NJ Family Care will automatically assign you to one of the three HMOs to prevent dis-enrollment and discontinuation of services.

I am a single adult on Plan H, and I just got pregnant. How will my benefits change?

If you are pregnant, you need to enroll in a different plan, called NJ Cares for Pregnant Women, for coverage during your pregnancy. You can enroll automatically when you go to your health care provider for care. This plan will provide you with more medical services while you are pregnant and for 60 days after you give birth. Because enrollment for NJ FamilyCare is now closed to adults, you won't be able to go back to NJ FamilyCare coverage after your pregnancy unless you have a very low income and are eligible for AFDC-Medicaid. Your caseworker should be able to help you to find out if you meet these requirements.

My children and I are all on NJ FamilyCare. I am pregnant now. Will my benefits change?

During your pregnancy, you must sign up for benefits through the NJ Cares for Pregnant Women Program that is administered through your county Board of Social Services, and you will continue to be covered by this program up to 60 days after delivery. After the 60 days, you will be switched back to NJ FamilyCare if you still qualify and are still eligible. If you have a problem getting back on to NJ FamilyCare, you may call us or NJ FamilyCare directly at the numbers listed above.

I am a Legal Permanent Resident who has been in the U.S. less than five years. Will my benefits change?

You will be placed into Plan H, even if your spouse is a citizen. Your children will stay in their current plan, depending on your income. Services under Plan H are limited because it no longer covers maternity and newborn services, hospice, optometrist services, vision care and eyeglasses, podiatrist services, outpatient rehabilitation, family planning, prosthetic appliances, organ transplant, services, or private duty nursing.

This article originally appeared in the December 2003 issue of Looking Out for Your Legal Rights®.