New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 79 - NJ FAMILYCARE-CHILDREN'S PROGRAM › Subchapter 2 - CASE PROCESSING › Section 10:79-2.3 - Application processing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Statewide
				eligibility determination agency or CWA shall screen all mail-in and walk-in
				applications against the existing Medicaid eligibility file. Applications that
				involve family members who are already enrolled in the Medicaid program shall
				be forwarded to the applicable eligibility determination agency for inclusion
				in the existing case, as appropriate. The eligibility determination agencies
				are required to refer any child found not eligible for Medicaid or any child
				losing eligibility for Medicaid or NJ FamilyCare-Children's Program-Plan A to
				the NJ FamilyCare-Children's Program-Plan B, C, and D program. The CWA should
				process all applications mailed or forwarded to them or all walk-ins for NJ
				FamilyCare-Children's Program-Plan A if the child's family income appears to
				meet the income standards. NJ FamilyCare-Plan A cases that are enrolled in a
				managed care organization (MCO) that are under the jurisdiction of the CWA and
				who would qualify for NJ FamilyCare-Plan B solely due to an increase of
				household income can be retained at the CWA.
(b) The eligibility determination agency is
				required to verify all factors related to eligibility for the NJ
				FamilyCare-Children's Program. Factors subject to verification include:
1. Birth date: The birth date of any child
				for whom benefits are sought must be provided. If there is a discrepancy
				between the age reported by the applicant and the age appearing on the Medicaid
				record, and the discrepancy affects eligibility or categorical requirement,
				then documentation shall be requested;
2. Citizenship: For applicants whose family
				income appears to meet the income standards for NJ FamilyCare-Children's
				Program-Plan A, the child's citizenship and identity must be verified as
				required by Section 6036 of the Deficit Reduction Act of 2005 (109 P.L. 171 ).
				For applicants whose family income appears to meet the income standards for NJ
				FamilyCare-Children's Program-Plans B, C or D, verification of citizenship may
				be requested if the child's U.S. citizenship is not certain;
3. Alien status: If the child is not a U.S.
				citizen, the alien status must be verified;
4. Household composition: The eligibility
				determination agency must verify the household composition in order to
				ascertain which persons will be included in the determination of eligibility
				for NJ FamilyCare-Children's Program benefits;
5. Social Security number: A Social Security
				number is not required in order to apply for NJ FamilyCare-Children's Program
				benefits under this chapter, which are provided under Title XXI of the Social
				Security Act. In the event that a child is found to be otherwise eligible for
				Medicaid coverage under Title XIX of the Social Security Act, a Social Security
				number would be required in order to enroll the child in that
				program;
6. Eligibility for or
				coverage under other health insurance; and
7. The eligibility determination agency must
				verify all sources of income of any person whose income must be counted in the
				determination of program eligibility. While resources are not a factor of
				eligibility for benefits for children under this chapter, resources must be
				identified and verified to determine if income is derived from the
				resources.