Navigating hospital bills can be overwhelming, especially when you’re uninsured or facing significant medical expenses. Fortunately, New Jersey offers a crucial safety net: the Hospital Care Payment Assistance Program, often referred to as Charity Care. This program is designed to help eligible New Jersey residents access necessary hospital care without the burden of unaffordable medical bills. Understanding how Charity Care works and whether you qualify can provide significant peace of mind and financial relief.
Understanding Charity Care Eligibility in New Jersey
Charity Care eligibility in New Jersey is primarily based on your annual gross income, calculated at the time you receive hospital care. The program uses the federal poverty level (FPL) as a benchmark, which is adjusted annually to reflect changes in the cost of living. Your family size, including yourself, your spouse, dependent minor children, and any adults for whom you are legally responsible, is also considered when determining eligibility.
Income Limits for Full Coverage
You will qualify for full Charity Care coverage if your annual gross income is at or below 200% of the federal poverty level (FPL). To find the current FPL based on your family size, you can refer to the Poverty Guidelines provided by the Assistant Secretary for Planning and Evaluation. This ensures the most up-to-date income thresholds for eligibility.
Income Limits for Partial Coverage
If your annual gross income falls between 200% and 300% of the FPL, you may still be eligible for partial Charity Care coverage. In these cases, Charity Care will cover a percentage of your hospital bill. The exact percentage you’re responsible for paying is determined using a sliding income scale. This scale is detailed in the New Jersey Hospital Care Payment Assistance Fact Sheet from the New Jersey State Department of Health. This fact sheet outlines the different levels of assistance available based on income within this range.
What if Your Income is Over 300% of FPL?
Even if your income exceeds 300% of the FPL, Charity Care might still be an option under specific circumstances. If your medical expenses are exceptionally high – specifically, if they are greater than 30% of your family’s annual income – and you meet the program’s asset limits, Charity Care can cover the portion of your medical bills that exceeds this 30% threshold. This provision is designed to protect families from catastrophic medical debt.
Asset Limits
In addition to income limits, Charity Care also considers asset limits. For individuals, the asset limit is $7,500, and for families, it is $15,000. However, there is a provision to help those whose assets initially exceed these limits. You are allowed to “spend down” your assets by using them to pay towards the outstanding hospital bill. Once your assets fall within the Charity Care limits, you can become eligible for coverage for the remaining balance of your bill.
How Hospitals Calculate Your Bill if Uninsured
New Jersey law includes protections for uninsured patients even beyond Charity Care eligibility. These regulations ensure that hospital charges are reasonable and aligned with typical healthcare costs.
Medicare Rate Cap
For uninsured patients whose income is below 500% of the FPL, New Jersey hospitals are legally restricted to charging no more than 115% of what Medicare would pay for the same services. Medicare’s fee schedules are publicly accessible and can be found by referencing CPT codes (Current Procedural Technology, 4th Edition) on the Centers for Medicare & Medicaid Services (CMS) website. This regulation ensures that uninsured patients are not subjected to inflated charges.
Sliding Scale for Partial Payments
The law also mandated the creation of a sliding scale to determine the percentage of the 115% of the Medicare rate that uninsured patients would need to pay, based on their income. While this specific sliding scale is not yet fully established by the State, the principle of income-based discounts is already in effect. Therefore, if your income is between 200% and 300% of the poverty level, any Charity Care discount you are eligible for is applied after your bill has already been adjusted down to no more than 115% of the Medicare rate. This double layer of protection helps to significantly reduce hospital costs for eligible patients.
Additional Help: Catastrophic Illness in Children Relief Fund
For families in New Jersey facing extraordinary medical expenses for children, the state offers another vital resource: the Catastrophic Illness in Children Relief Fund. This program is specifically for children with very large medical bills that are not fully covered by insurance or other assistance programs. For more detailed information and application procedures, you can visit the Catastrophic Illness in Children Relief Fund website or call their helpline at 1-800-335-FUND (3863).
Conclusion
The New Jersey Hospital Care Payment Assistance Program (Charity Care) is a critical resource for residents struggling to afford hospital care. By understanding the income and asset eligibility requirements, as well as the regulations protecting uninsured patients from excessive charges, you can access the financial assistance you need. If you believe you may be eligible for Charity Care or have questions about your hospital bill, it’s crucial to contact the hospital’s billing department or explore the resources provided by the New Jersey Department of Health and the Catastrophic Illness in Children Relief Fund for further support.
This information was last reviewed: January 16, 2024.
