LEGISLATIVE FISCAL ESTIMATE

ASSEMBLY, No. 5052

STATE OF NEW JERSEY

221st LEGISLATURE

 

DATED: DECEMBER 19, 2025

 

 

SUMMARY

 

Synopsis:

Requires health insurance and Medicaid coverage for screening, prevention, and treatment services of behavioral health issues affecting children.

Type of Impact:

Annual State expenditure and revenue increases; annual expenditure increase for certain local government units and school districts.

Agencies Affected:

Division of Pensions and Benefits in the Department of the Treasury; Department of Human Services; certain local government units and school districts.

 

Office of Legislative Services Estimate

Fiscal Impact

 

Annual 

 

 

State Expenditure Increase for SHBP

 

Indeterminate

 

 

Local Expenditure Increase for SHBP-Local and SEHBP

 

Indeterminate

 

 

State Expenditure Increase for NJ FamilyCare

 

Indeterminate

 

 

State Revenue Increase under NJ FamilyCare

 

Indeterminate

 

 

 

·       The Office of Legislative Services (OLS) estimates that requiring the State Health Benefits Program, the School Employees’ Health Benefits Program, and the NJ FamilyCare program to provide coverage for screening, prevention, and treatment services for children diagnosed as being at risk for behavioral health issues will result in indeterminate annual State and local expenditure increases.

 

·       The OLS finds the expenditure increases under the bill could be millions of dollars annually, but lacks the empirical basis to provide a more precise estimate.

 

·       Any increase in State expenditures under the NJ FamilyCare program will be eligible for additional federal Medicaid reimbursements, thereby increasing State revenues, albeit by an indeterminate amount.

 

 

BILL DESCRIPTION

 

      This bill requires health insurers, including the State Health Benefits Program, the School Employees’ Health Benefits Program, and the NJ FamilyCare/Medicaid Program to provide coverage for the screening, prevention, and treatment services of behavioral health issues affecting children using an at-risk diagnosis.

 

 

FISCAL ANALYSIS

 

EXECUTIVE BRANCH

 

      None received.

 

OFFICE OF LEGISLATIVE SERVICES

 

      The OLS estimates that requiring the State Health Benefits Program, the School Employees’ Health Benefits Program, and the NJ FamilyCare program to provide coverage for screening, prevention, and treatment services for children diagnosed as being at risk for behavioral health issues will result in indeterminate annual State and local expenditure increases.  The OLS finds the expenditure increases under the bill could be millions of dollars annually, but lacks the empirical basis to provide a more precise estimate. 

      The National Center for Health Statistics reports that, based on data from its 2021 National Health Interview Survey, approximately 14.9 percent of children ages five through 17 received mental health treatment in the previous 12 months.  Based on this information, the OLS estimates that the State part of the State Health Benefits Program covers approximately 8,700 children who may require assessment and treatment services pertaining to behavioral health issues.  The OLS also estimates the local part of the State Health Benefits Program and the School Employees’ Health Benefits Program cover approximately 4,500 and 6,500 children, respectively, who may require assessment and treatment services pertaining to behavioral health issues.  Additionally, based on research found on the National Institutes of Health website and other information, the OLS estimates the average annual cost for the assessment and treatment of children with behavioral health issues is approximately $2,200.  However, given that the OLS cannot predict how many children will receive the screening, prevention, and treatment services nor the specific types of services that will be utilized, the annual cost increases are indeterminate.

      In regard to NJ FamilyCare, to the extent that the annual screenings and treatment services, which would include individual, group, and family psychotherapy and other preventive services for a subset of screened children, increase costs for the NJ FamilyCare managed care organizations, the State may face upward pressure on the monthly capitation rates paid to the NJ FamilyCare managed care organizations.  The OLS, however, cannot determine the magnitude of any potential expenditure increases, given that the number of children who will be screened, referred for psychotherapy or other preventive services, and for whom parental consent for preventive services will be given, is uncertain.  For context, according to the November 2025 NJ FamilyCare enrollment report published by the Department of Human Services, there were 829,429 children under the age of 21 enrolled in the program in the month in question.  This number does not include children who qualify for benefits due to a disability.

      The OLS notes that an increase in State expenditures under the NJ FamilyCare program will be eligible for additional federal Medicaid reimbursements, thereby increasing State revenues, albeit by an indeterminate amount.

Section:

State Government

Analyst:

Camryn Mathews

Associate Fiscal Analyst

Approved:

Thomas Koenig

Legislative Budget and Finance Officer

 

 

This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.

 

This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).