New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 90 - WORK FIRST NEW JERSEY PROGRAM › Subchapter 13 - MEDICAL SERVICES FOR WFNJ SINGLE ADULTS AND COUPLES WITHOUT DEPENDENT CHILDREN › Section 10:90-13.6 - Medically needy

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Individuals and
				families who are ineligible for WFNJ/GA, WFNJ/TANF, the Refugee Resettlement
				Program or SSI, because their income exceeds the standards established for the
				applicable program may apply to the county/municipal agency on a monthly basis
				for assistance in paying excessive medical costs. The provisions of this
				subsection are not applicable to the payment of bills for inpatient or
				outpatient hospitalization or for medical services rendered to an inpatient or
				outpatient by a hospital or hospital clinic. Those individuals who appear to be
				potentially eligible for the Medically Needy Program shall be referred to that
				program. Except as stated in (b) below, any person found eligible under the
				provisions of that program is not eligible for benefits under this
				subsection.
(b) Elderly, blind or
				disabled individuals who are ineligible for the SSI Program, because their
				income exceeds the SSI standard, shall be referred to the Medically Needy
				Program. That program, however, does not provide payment for prescribed drugs.
				Therefore, individuals not entitled to receive assistance in meeting the cost
				of drugs from any other source may apply to the county/municipal agency on a
				monthly basis for assistance in meeting excessive medical costs.
(c) When an individual's or family's income
				over and above the appropriate income level as explained in (d) below has been
				used to pay medical bills, any additional medical costs are considered
				excessive.
(d) For the purpose of
				determining excessive medical costs, the total available monthly income (see
				(e) below) of individuals, couples, or families with children is measured
				against the appropriate allowance standard. For elderly, blind, or disabled
				persons, the Medically Needy Program standard applies. For families with
				children, Schedule II applies (see
				10:90-3.3(b)  ).
				For all others, Schedule IV (see
				10:90-3.5(b)  )
				or V (see 10:90-3.6(a)  ),
				as appropriate, applies. Information about the current standards may be
				obtained by contacting the Division of Family Development.
(e) Form WFNJ/GA-19 will be used to determine
				income and the amount of excessive medical costs. Monthly earned income is
				adjusted by deducting any earned disregard, as appropriate (see
				10:90-3.8 ), plus any child care
				necessary for employment of the parent(s) and/or court ordered support
				payments; no further disregards are recognized. This adjusted amount added to
				any unearned income equals the total monthly income available to the eligible
				unit.
(f) When the appropriate
				standard ((d) above) is subtracted from the total available income, the
				difference or "surplus" is the amount of medical expenses the client is
				expected to pay him or herself. When the client has proof of paid medical bills
				in the amount of the "surplus," the agency shall provide payment for any unpaid
				medical costs in excess of the "surplus," in accordance with the regulations
				and rates set forth in this subchapter.
(g)
									10:90-1.2 and 2.11(b) shall
				constitute the application process relevant to the medically needy. See also
				10:90-3.22 regarding
				redeterminations.