Presumptive Eligibility Provider Training

Beginning January 2014, NJ FamilyCare – New Jersey’s publicly funded health insurance program – includes CHIP, Medicaid and Medicaid expansion populations. That means qualified New Jersey residents of any age may be eligible for free or low cost health insurance that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services and even hospitalization.

Presumptive Eligibility (PE) for NJ FamilyCare offers temporary medical insurance for services provided by participating providers while NJ FamilyCare applications are pending an eligibility determination. Certified staff within acute care hospitals, federally qualified health centers (FQHCs), primary care provider offices, substance use and mental health provider offices, as well as local health departments can “presume eligible” for NJ FamilyCare an uninsured patient presenting for care who appears to meet income and other eligibility requirements. PE is self-attested, so no supporting documentation is needed for PE to be established. These facilities are paid directly by the state for services provided once PE eligibility is established. It is recommended that a provider apply for PE on behalf of a patient, if they meet eligibility criteria, before applying for Charity Care or Uncompensated Care.

PE providers must be trained and credentialed by the State Presumptive Eligibility Unit. For more information about PE Provider Training, please contact the PE Unit at 609-588-2911 or email MAHS.PE.Response@dhs.nj.gov.