A6064

An Act concerning medical relief for certain individuals, supplementing Title 30 of the Revised Statutes, and making an appropriation.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. As used in this act:

“Department” means the Department of Human Services.

“Electronic benefits transfer card” means the payment card used or intended for use to access medical relief benefits under the electronic benefit distribution system established pursuant to section 5 of P.L.1997, c.37 (C.44:10-75), on which medical relief funds shall be deposited, and through which recipients can pay for qualifying medical services provided pursuant to this act.

“Eligibility redetermination" means the administrative process by which the Division of Medical Assistance and Health Services in the Department of Human Services or a county social services agency reviews an enrollee’s income, financial resources, and circumstances relating to the beneficiary's application for continuation of benefits received under Medicaid or NJ FamilyCare.

“Eligible individuals” means NJ FamilyCare enrollees who are disenrolled due to the following provisions of the federal “One Big Beautiful Bill Act (OBBBA),” Pub.L. 119-21:

a. section 71107, concerning frequency of eligibility redeterminations for continued enrollment in Medicaid and the Children’s Health Insurance Program;

b. section 71109, concerning immigrant eligibility for Medicaid and the Children’s Health Insurance Program benefits; or

c. section 71119, concerning Medicaid community engagement requirements for certain enrollees.

“Medicaid” means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

“NJ FamilyCare” means the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.) which includes the Children’s Health Insurance Program (CHIP).

“Participating medical relief services provider” means a State licensed advanced practice nurse, clinical social worker, professional counselor, physician, physician assistant, psychiatrist, psychologist, or social worker, acute care hospital, or pharmacy that has registered with the Department of Human Services to provide qualifying medical services to eligible individuals under the State’s medical relief program.

“Qualifying medical services” means the following outpatient medical care and services, when purchased by an eligible individual with medical relief funds made available on an electronic benefits transfer card issued to the eligible individual: hospital emergency room, physician, prescription drugs, and behavioral health services.

2. a. Notwithstanding the provisions of any law or regulation to the contrary, and conditioned upon the State’s continued eligibility for federal financial participation for State expenditures under the federal Medicaid and Children’s Health Insurance Programs, the Commissioner of Human Services shall establish a State medical relief program to provide funding that eligible individuals may use to purchase qualifying medical services from a participating medical relief services provider, following the eligible individual’s disenrollment from the NJ FamilyCare program due to the federal “One Big Beautiful Bill Act,” Pub.L. 119-21.

b. On an annual basis, and subject to the availability of funding pursuant to section 9 of this act, the commissioner shall determine the amount of medical relief benefits to be provided, in an equal allotment across the pool of eligible individuals, to an eligible individual.

c. (1) The commissioner shall provide the amount of an eligible individual’s medical relief benefits for a 12-month period on an electronic benefits transfer card at the time that the individual is first determined eligible for benefits, and upon subsequent determination, made by the Department of Human Services pursuant to subsection c. of section 4 of this act, that the individual remains eligible for benefits under the State medical relief program.

(2) The department shall review and determine an eligible individual’s continued eligibility for medical relief benefits no later than 12 months from the date of the previous determination, timed to coincide with an eligible individual’s NJ FamilyCare eligibility redetermination, if applicable.

(3) (a) Medical relief benefits shall be available for expenditure on qualifying medical services for a 12-month period, beginning on the day on which the benefits are issued to the eligible individual, or until such time as the benefits have been expended, whichever is earlier.

(b) If an eligible individual expends the full amount of the individual’s medical relief benefits before the end of the 12-month period following the issue date, no additional medical relief benefits shall be made available to the eligible individual until the date on which the department determines that the individual remains eligible for medical relief benefits for another 12-month period.

(c) An eligible individual, who expends the full amount of the individual’s allocated medical relief benefits, may purchase qualifying medical services from a participating medical relief services provider at a rate that is equal to the NJ FamilyCare reimbursement rate for the identical service, as provided pursuant to subsection b. of section 5 of this act.

d. Any medical relief benefits, provided pursuant to subsection a. of this section, which remain unexpended at the conclusion of an eligible individual’s 12-month period, shall be returned to the department for deposit into the General Fund.

e. The commissioner shall establish an online portal and a process by which an eligible individual may view claims for qualifying medical services that have been paid from the eligible individual’s medical relief benefits pursuant to this section, and any remaining medical relief benefits.

f. The medical relief benefits provided pursuant to subsection a. of this section shall not constitute comprehensive health insurance for the purposes of determining an eligible individual’s eligibility for medical services, provided on a sliding fee scale based on income and health insurance status, at a federally qualified health center.

g. Under no circumstances shall an eligible individual be required to participate in the State medical relief program established pursuant to subsection a. of this section.

3. a. Upon notification that an individual has been disenrolled from the NJ FamilyCare program due to the federal “One Big Beautiful Bill Act,” Pub.L. 119-21, the Commissioner of Human Services shall enroll the eligible individual in the State medical relief program on a provisional basis, which enrollment shall entitle the eligible individual to medical relief benefits provided pursuant to subsection a. of section 2 of this act, until the earlier of:

(1) the date on which the Department of Human Services approves the individual’s application for medical relief benefits pursuant to subsection a. of section 2 of this act, at which time the individual’s eligibility will convert from provisional to full status;

(2) six months from the date on which the individual received notice from the department concerning the individual’s disenrollment from the NJ FamilyCare program due to the provisions of the federal “One Big Beautiful Bill Act,” Pub.L. 119-21,” unless the individual has a pending application for the State medical relief program;

(3) a determination by the department that the individual does not qualify for medical relief benefits according to the requirements established pursuant to subsection a. of section 2 of this act; or

(4) the individual notifies the department, on a form and according to a process established by the commissioner, that the individual does not wish to receive provisional medical relief benefits pursuant to this subsection.

b. An individual provisionally enrolled in the State medical relief program shall be entitled to all of the medical relief benefits provided pursuant to section 2 of this act.

c. At the time that the department approves an application for medical relief benefits submitted by a provisional medical relief recipient, the department shall convert the provisional medical relief benefits, allocated to the provisional medical relief participant’s electronic benefits transfer card, to full medical relief benefits status.

4. a. An eligible individual who has been disenrolled from the NJ FamilyCare program due to the provisions of the federal “One Big Beautiful Bill Act,” Pub.L. 119-21, may apply for medical relief benefits according to a process to be established by the Commissioner of Human Services.

b. The commissioner shall publish information on the State medical relief program and the process by which an eligible individual may apply for medical relief benefits on the Department of Human Services’ website. Print copies of this information shall also be made available in public locations, including, but not limited to:

(1) county social services agencies;

(2) any agency or office distributing food pursuant to the special supplemental food program for women, infants and children (WIC), established pursuant to P.L.1987, c.261 (C.26:1A-36.1 et seq.) and Pub.L. 95-267 (42 U.S.C. s.1786);

(3) acute care hospitals; and

(4) federally qualified health centers.

c. (1) The department shall redetermine an eligible individual’s continued eligibility for medical relief benefits no later than every 12 months from the date of the previous determination, timed to coincide with an eligible individual’s NJ FamilyCare eligibility determination, if applicable.

(2) An eligible individual’s continued eligibility for medical relief benefits, beyond the initial 12-month eligibility period, shall be determined according to criteria that shall be developed by the commissioner. These criteria shall include, but shall not be limited to, the eligible individual’s income, financial resources, and State residency.

(3) An eligible individual who receives medical relief benefits pursuant to subsection a. of section 2 of this act shall be required to reapply for the NJ FamilyCare program at each opportunity to do so, unless the eligible individual has been disenrolled from the NJ FamilyCare program due to the requirements of section 71109 of the federal “One Big Beautiful Bill Act,” Pub.L. 119-21.

(4) If, at the time of an eligible individual’s NJ FamilyCare redetermination, the department finds that the individual qualifies for the NJ FamilyCare program, the individual’s medical relief benefits shall be terminated according to a process established by the Commissioner of Human Services.

d. Under no circumstances shall an eligible individual be simultaneously enrolled in, and receive benefits under, both the State medical relief program and the NJ FamilyCare program.

5. a. The Commissioner of Human Services shall establish a process by which a licensed health care provider may register with the Department of Human Services to become a participating medical relief services provider under the medical relief program established pursuant to this act. At a minimum, information regarding the application process shall be made available on the department’s website and on the website of the State’s Medicaid fiscal agent.

b. Participating medical relief services providers shall agree to:

(1) accept medical relief benefits, accessed via an eligible individual’s electronic benefits transfer card pursuant to subsection c. of section 2 of this act, as payment for the provision of qualified medical services;

(2) charge an eligible individual for qualified medical services at the same rate charged to the NJ FamilyCare program for the identical service; and

(3) continue to provide qualified medical services, billed at the same rate charged to the NJ FamilyCare program for the identical service, for an eligible individual who has expended their medical relief benefits and chooses to self-pay for qualifying medical services.

6. a. The Commissioner of Human Services shall establish a process by which the Department of Human Services shall verify claims for qualifying medical relief services purchased by an eligible individual using medical relief funds.

b. At a frequency and according to a process to be determined by the commissioner, the department shall audit medical relief program expenditures in order to ensure the program’s financial integrity.

c. The commissioner shall establish a process to identify and refund to the State medical relief program any claims, originally paid using State medical relief program funds, that are reimbursable under the NJ FamilyCare program.

7. a. There is established in the Department of the Treasury a nonlapsing revolving fund to be known as the New Jersey Medical Relief Fund, which shall be the repository for: (1) funds annually appropriated by the Legislature for the State medical relief program; and (2) the annual amount of State funds that the State otherwise would expend to provide NJ FamilyCare coverage for eligible enrollees of the medical relief program absent the federal “One Big Beautiful Bill Act,” Pub.L. 119-21.

b. The State Treasurer shall be the custodian of the New Jersey Medical Relief Fund, and all disbursements from the fund shall be made by the State Treasurer upon certification by the Commissioner of Human Services or the commissioner’s designee. The monies in the fund shall be invested and reinvested by the Director of the Division of Investment in the Department of the Treasury in the same manner as other trust funds in the custody of the State Treasurer, in the manner provided by law. Interest received on the monies in the fund shall be credited to the fund.

c. The State Treasurer, in consultation with the Commissioner of Human Services, shall authorize the transfer of New Jersey Medical Relief Fund resources to the Department of Human Services to provide medical relief benefits via the electronic benefits transaction card issued to an eligible individual pursuant to subsection c. of section 2 of this act.

8. The State Treasurer and the Commissioner of Human Services shall, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as necessary to implement this act and to ensure that medical relief benefits are not used to supplant other forms of benefits maintained by eligible individuals.

9. There is appropriated from the General Fund to the New Jersey Medical Relief Fund the sum of $650,000,000, in addition to the amount of State funds that the State otherwise would expend to provide NJ FamilyCare benefits to eligible enrollees of the medical relief program absent the federal “One Big Beautiful Bill Act,” Pub.L. 119-21.

10. This act shall take effect on October 1, 2026, except the State Treasurer and the Commissioner of Human Services may take such anticipatory action in advance thereof as shall be necessary to implement the provisions of this act.

STATEMENT

This bill establishes the State medical relief program (the program) in the Department of Human Services (the department) to provide certain NJ FamilyCare enrollees, disenrolled from NJ FamilyCare benefits because of new eligibility suppressing conditions in the federal “One Big Beautiful Bill Act (OBBBA),” with limited medical relief funds for qualifying medical services. “Qualifying medical services” are the following outpatient services: hospital emergency room, physician, and behavioral health services, and prescription drugs. Individuals eligible for the program are those who lose NJ FamilyCare benefits due to certain OBBBA provisions: community engagement (work) requirements, more frequent eligibility redeterminations, and discontinuation of Medicaid and Children’s Health Insurance Program (CHIP) eligibility for certain “qualified immigrants.”

Medical relief benefits will be provided, in equal allotments to all eligible individuals, via an electronic benefits transfer (EBT) card, with which an eligible individual may purchase qualifying medical services from licensed medical providers who have registered with the department to participate in the program. The amount of an eligible individual’s medical relief benefit for a 12-month period, subject to the availability of State funding, will be determined annually by the Commissioner of Human Services (the commissioner) and deposited on the individual’s EBT card at the time of initial application approval, and at subsequent annual eligibility redeterminations. An eligible individual must reapply for the NJ FamilyCare program at each opportunity to do so, unless the eligible individual has been disenrolled from NJ FamilyCare due to the immigrant provisions of OBBBA.

Medical relief benefits will remain available for 12 months, or until fully expended. Once an individual has exhausted the individual’s medical relief benefits for a 12-month period, the individual may choose to self-pay for qualifying medical services from a participating provider, at a cost that equals the NJ FamilyCare rate for the identical service.

The commissioner will automatically enroll individuals who lose NJ FamilyCare benefits under OBBBA in the program on a provisional basis, unless the individual affirmatively opts out. Provisionally enrolled individuals will receive full medical relief benefits until: (1) the department approves the individual’s application for the program; (2) six months from the date that the individual was disenrolled from NJ FamilyCare; (3) the department determines that the individual does not qualify for medical relief benefits; or (4) the individual notifies the department that the individual wishes to opt out of the program.

Participating medical relief service providers must agree to accept medical relief benefits as payment for qualified medical services and to charge the NJ FamilyCare rate for qualified medical services provided under the program.

The bill establishes the New Jersey Medical Relief Fund (the fund) in the Department of the Treasury as a nonlapsing revolving fund, which will be the repository for Legislative appropriations for the program, plus the amount of State funding, as determined by the commissioner, that the State otherwise would have expended to provide NJ FamilyCare benefits for program participants.

This bill appropriates $650 million to the fund, as well as the unexpended State funds resulting from NJ FamilyCare enrollees shifting to the program. The bill’s provisions will take effect on October 1, 2026, but the State Treasurer and the commissioner may take actions prior to this date to implement the bill’s requirements.