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The 1965 federal law, Social Security Act Section 1905(a), prohibits Medicaid federal financial participation (FFP) for medical care or services for inmates in a public institution, except as a patient in a medical institution.  State law also prohibits the use of state Medicaid funds to cover inmate care as referenced in NJSA 30:4D-6 (e) and 42 CFR ยง435.101 whereby incarcerated individuals who are expected to be hospitalized for a 24-hour period, or longer, at a medical institution are not considered to be an inmate during that time and can be covered by Medicaid, if otherwise eligible.  The State Fiscal Year 2015 Appropriations Act requires that the NJ Department of Human Services work with the county corrections agencies to promote NJ FamilyCare enrollment of all eligible inmates requiring inpatient hospitalization.  

NJ FamilyCare Presumptive Eligibility provides temporary NJ FamilyCare health coverage while full NJ FamilyCare eligibility is being determined.  NJ FamilyCare Presumptive Eligibility (PE) training for hospital PE providers, county welfare agency directors, and county correctional staff was held on August 11, 2014.  The Division of Medical Assistance and Health Services presented solutions for paying hospitalization expenses for eligible inmates beginning September 1, 2014. 


Slide Presentation: NJ FamilyCare and Hosptalized Inmates

Frequently Asked Questions (FAQs) about NJ FamilyCare Presumptive Eligibility for Inmates

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