From the LRRC Case Files - Week 3

Case

Nechama Weiss worked in an office as a secretary, earned $20k a year and was on NJ FamilyCare. During her time as a secretary, she found out that she was pregnant with her first child. Two months later, she was promoted to a managerial position with a salary of $45k. When she reported her change of income to NJ FamilyCare, she was told that her new raise would bump her over the income limit and she was therefore being terminated from NJ Family Care. This was a surprise to Nechama, because one of her co-workers had also received an identical promotion and was also expecting her first child, yet she was still being covered by NJ FamilyCare.

Question: Why is Nechama being terminated from NJ FamilyCare while her co-worker is still being provided with insurance?

Answer: We get this question several times a day, and the answer is simple. Nechama did not report her pregnancy to NJ FamilyCare until after she had received a raise, whereas her co-worker had informed NJ FamilyCare of her pregnancy right away. With an annual salary of $45k a year and a first child on the way, neither Nechama nor her coworker is actually eligible to receive NJ FamilyCare. However, since Nechama's co-worker had reported her pregnancy when she was still making $20k, government policy dictates that she is guaranteed coverage for the duration of her pregnancy.

This is an important point that people do not necessarily understand. When a woman finds out that she is expecting, she should immediately inform NJ FamilyCare of her new status. Once she is approved by NJ FamilyCare, she is guaranteed coverage for the duration of her pregnancy as well as for two months after the birth ' regardless of any income changes that take place during this period. Her child is also guaranteed coverage for an entire year after birth. If one has a change in income during her pregnancy, she must inform NJ FamilyCare. However, the expecting mother will still receive coverage for the rest of the pregnancy.

Unfortunately, Nechama informed NJ FamilyCare of her pregnancy too late and is no longer qualified to receive coverage.

Top Tips from Mrs. Friedman - Phone Case Manager

Number of encounters in the past month: 660

Key Skills:

In-depth knowledge of NJ FamilyCare, SNAP, CHIP, CHS, and Utility Programs
Caring and devoted ' Follows up and sees clients through the eligibility and application processes until they have a satisfactory resolution
For a number of years, the phone hold times for the LRRC were pretty rough. Despite all our staff working together, the phones often got backed up during peak times, leading to frustrating wait times. During the quieter times of the day, the phone queue would be manageable, but if too many people called at once, the backlog grew. To address this problem, the LRRC set up a call-back system. With this new system, every call is quickly (usually within a minute) answered by a receptionist who schedules a slot (usually later that day) when a case worker will call the client to discuss their question. Because of the enormous amount of people who call us every day, we allocate 5-8 minutes per person for each phone appointment.

It can sometimes be frustrating to know that you only have a few minutes to speak to a case worker. If, at the end of the phone conversation, you have more questions you want to discuss, or you feel unclear about an issue and would like more time, simply ask for more time and we will be happy to schedule you a full in-person appointment or another phone call to continue the conversation.'