New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 2 - THE APPLICATION PROCESS › Section 10:71-2.1 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings unless the context clearly indicates
				  otherwise:
"Application process" means all activity performed by the
				  Income Maintenance Section relating to a request for medical assistance
				  payments. The application process is primarily geared toward the determination
				  of basic eligibility. However, since intake by its very nature involves a
				  combination of services and income maintenance functions, a service worker
				  shall be available as required during such process.
"Applicant," in Medicaid Only, means the aged, disabled or
				  blind individual or his/her authorized agent who executes the formal written
				  application (PA-1G).
"Approved" means that the applicant has been determined to be
				  eligible for Medicaid Only.
"County welfare agency (CWA)" means that agency of county
				  government, that is charged with the responsibility for determining eligibility
				  for public assistance programs, including AFDC-Related Medicaid, Temporary
				  Assistance to Needy Families (TANF), the Food Stamp Program, NJ FamilyCare and
				  Medicaid. Depending on the county, the CWA might be identified as the board of
				  social services, the welfare board, the division of welfare or the division of
				  social services.
"Department of Human Services (DHS)" means the New Jersey
				  Department of Human Services.
"Disposition of the application" means the official
				  determination of the CWA that one of the following actions is appropriate:
				  approval or rejection as defined in the section.
"DRA" means the Federal Deficit Reduction Act of 2005,
				  P.L.
				  109-171.
"MRT" means Medical Review Team.
"New application" means a written request for assistance from
				  an individual or his/her agent who has never previously requested assistance in
				  any county in the State under the Medicaid Only program.
"Pending application" means the general term for application,
				  reapplication, reopened application or transfer application prior to official
				  disposition.
"Poverty guidelines" means, with respect to a household, the
				  income poverty line as prescribed and revised at least annually pursuant to
				  42
				  U.S.C. §
										9902(2). The
				  poverty guidelines are a simplified version of the Federal Government's
				  statistical poverty thresholds used by the Census Bureau to prepare its
				  statistical estimates of the number of persons and families in poverty. The
				  poverty guidelines issued by the Department of Health and Human Services
				  pursuant to
				  42
				  U.S.C. §
										9902(2) are
				  used for administrative purposes, for example, for determining whether a person
				  or family is financially eligible for assistance or services under a particular
				  Federal program.
"Reapplication" means a written request for assistance by the
				  individual whose previous application was rejected in any county in the State
				  and who requests reconsideration of his/her current eligibility for Medicaid
				  Only.
"Registration" means the action of the CWA in assigning a
				  control number to an application.
"Rejected" is an inclusive term (for statistical purposes)
				  for the following actions:
1. Denied means that the applicant has been determined to be
				  ineligible for assistance for a specific reason.
2. Dismissed means official recognition that eligibility need
				  not be considered further because:
i. The applicant died (however, if there were unpaid medical
				  bills incurred subsequent to inquiry or application, whichever occurred first,
				  the application process is to be completed); or
ii. The applicant cannot be located; or
iii. The application was registered in error; or
iv. The applicant moved to another county in New Jersey
				  during the application process.
3. Withdrawn means that the applicant decided not to pursue
				  the application further.
"Reopened application" means a written request by a former
				  beneficiary in any county in the State for reconsideration of his or her
				  current eligibility for the program.
"State Verification Exchange System (SVES)" means the Social
				  Security Administration's database, which provides states with a standardized
				  method of Social Security number verification and uniform data response.
"Transfer application" means a written request for assistance
				  by the individual who at the time of registration is still receiving assistance
				  through the CWA of another county from which he or she moved.