New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL › Subchapter 4 - FINANCIAL ELIGIBILITY › Section 10:72-4.1 - Income eligibility limits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Income limits
				for Medicaid for aged, blind, and disabled persons (except for specified
				low-income Medicare beneficiaries), covered under the provisions of this
				chapter will be based on 100 percent of the poverty income guidelines as
				defined by the U.S. Department of Health and Human Services in accordance with
				sections 652 and 673(2) of the Omnibus Budget Reconciliation Act of 1981 (
				Pub.L. 97-35 ). The monthly income standard will be 1/12 of the annual poverty
				income guideline rounded down to the next whole dollar amount for household
				unit sizes of one and two for aged, blind, and disabled individuals. The annual
				revision to the Federal poverty income guideline will be effective for purposes
				of this section with the first day of the year for which the poverty income
				guideline is promulgated.
(b)
				Effective with the first month of coverage, January 1, 1993, income limits for
				specified low-income Medicare beneficiaries shall be based on 110 percent of
				the poverty income guidelines as defined by the U.S. Department of Health and
				Human Services in accordance with Sections 1902(a)(10)(E)iii of the Social
				Security Act,
				42 U.S.C.
				1396 a. Effective January 1, 1995, the income
				limits will be set at 120 percent of the Federal poverty level.
(c) Income limits for pregnant women and
				children under the age of one year covered under the provisions of this chapter
				shall be based on 185 percent of the poverty income guideline as defined by the
				Department of Health and Human Services in accordance with sections 652 and
				673(2) of the Omnibus Budget Reconciliation Act of 1981 ( Pub.L. 97-35 ). The
				monthly income standard will be one-twelfth of 185 percent of the annual
				poverty income guideline rounded down to the next whole dollar amount for each
				household size. The annual revision to the Federal poverty income guideline
				will be effective for the purposes of this section with the first day of the
				year for which the poverty guideline is promulgated.
(d) In order to be eligible for Medicaid
				benefits under the provisions of this chapter, monthly household income (as
				determined by this chapter) must be equal to or less than the income limit
				established in (a), (b) or (c) above as applicable.
1. If a pregnant woman is determined to be
				income eligible during any month prior to the end of her pregnancy, she, if
				otherwise eligible, will continue eligible without regard to changes in the
				household unit's income for the term of her pregnancy, including the 60-day
				period beginning with the last day of the pregnancy whether or not the
				pregnancy results in a live birth. If the income change results from the
				addition of a new household member, the new income is not considered through
				the 60-day period beginning with the last day of the pregnancy.
i. The child resulting from the pregnancy
				will be eligible for Medicaid without regard to changes in the household unit's
				income for a period of not less than 60 days and up to a period of one year, so
				long as the mother remains eligible for Medicaid, or would remain eligible if
				pregnant, and the child remains in the mother's custody.
ii. A pregnant woman who, during the course
				of the pregnancy, was receiving or would have been eligible to receive AFDC
				benefits using the eligibility rules in existence as of July 16, 1996. Medicaid
				Special, or Medicaid for the Unborn is deemed to have met the income
				requirements of this chapter.