reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.3 - Purpose and scope of first contact

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				responsibility of the agency during the initial contact shall include, but not
				be limited, to:
1. Determining and explaining
				the medical assistance program for which the client may be eligible and
				informing the client how and where to apply;
2. Advising individual of general
				requirements of the application process, for example, the necessity of
				contacting certain relatives and of certain other collateral contacts with an
				explanation of the right of the applicant to confidentiality and to be primary
				source of information. The application form includes a blanket consent
				statement. The client should be informed that he or she is consenting to have
				the CWA contact others by signing this form. The consent statement on the
				application form authorizes the CWA to contact such individuals and agencies to
				confirm the income of the applicant including, but not limited to, family
				members, the State Division of Taxation, landlords, employers, and banks, or
				other financial institutions. The eligibility worker shall specifically advise
				each applicant that by signing the waiver he or she is granting such an
				authorization. In addition to such oral explanations, the individual shall be
				provided with the pamphlet, Medicaid Rights and Responsibilities;
3. Advising individual that Title VI of the
				Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 and the
				Americans with Disabilities Act (ADA),
				Pub. L.
				101-336, codified as
				42 U.S.C. §§
											12101 et seq., prohibit discrimination in
				determining eligibility for AFDC-related Medicaid;
4. Determining whether the individual does
				indeed wish to apply with full understanding of the need to verify essential
				eligibility factors;
5. Taking the
				application without delay; and
6.
				Advising a pregnant woman that she may make application for New Jersey Care ...
				Special Medicaid Programs.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.4 - Completion of forms

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The applicant will be fully assisted by
				the eligibility worker or by any person of his or her choice in completing the
				Application and Affidavit for AFDC-related Medicaid (PA-1J). Form PA-1J is used
				to apply for AFDC-related Medicaid.
(b) The applicant's signature(s) and the date
				of application are required. The PA-1J requires three signatures of the
				applicant(s). In addition to the first page and the affidavit, the
				applicant(s), with the exception of non-needy parent-persons who do not request
				medical assistance for themselves, shall sign a release that authorizes the CWA
				to obtain State income tax information.
1. In
				AFDC-C-related Medicaid, a written application and the authorization to obtain
				State income tax information is to be signed under oath by the applicant
				himself or herself or, when the applicant is incapacitated or alleged
				incompetent (10:69-3.12(b)  ),
				by someone acting responsibly for him or her.
i. When both parents are in the home, both
				shall be required to sign the application and the authorization to obtain State
				income tax information except that if a parent is unavailable to sign the
				application and the authorization to obtain State income tax information for
				reasons beyond the family's control, one signature will suffice. In that event,
				the non-signatory parent shall be required to annex his or her signature as
				promptly as he or she is available for such purposes.
ii. A non-needy parent-person who does not
				make application for AFDC-related Medicaid for himself or herself is required
				to sign the application but is not required to sign the authorization to obtain
				State income tax information. This exception does not apply to natural or
				adoptive parents.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.5 - Registration of applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Official
				registration of an application shall include:
1. Entry in an application register under
				appropriate classification; and
2.
				Assignment of a registration number.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.6 - Eligibility for AFDC-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Eligibility for
				AFDC-related Medicaid is based upon certain criteria such as age, relationship,
				residence in the State, alien status and upon other criteria relevant to each
				segment.
(b) Eligibility for the
				AFDC-C-related Medicaid segment is based on financial need and deprivation of
				parental support and care by reason of mental or physical incapacity, absence
				or death of one or both parents.
(c) Eligibility for the AFDC-F segment is
				based on financial need when both parents are in the home, neither is
				incapacitated and the parent who is the principal earner meets the Federal
				definition of unemployment.
(d) All
				AFDC-F clients shall be advised that their eligibility for these segments is
				based on the fact that there are two parents who are not incapacitated in the
				home and that, if a parent dies, becomes incapacitated or leaves the household,
				this fact should be brought to the attention of their eligibility worker so
				that an application for AFDC-C-related Medicaid and/or referral to SSI can be
				considered.
(e) Income standards
				for persons eligible under the AFDC-C-related and-F-related Medicaid appear at
				N.J.A.C.
				10:69-10.3.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.7 - Financial need

Current through Register Vol. 56, No. 14, July 15, 2024
The eligibility worker shall determine financial eligibility
				  (need) of the eligible family members by Form 105, if appropriate, in
				  accordance with this subchapter.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.8 - Eligibility factors other than need

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In verifying
				eligibility, the eligibility worker shall take whatever action is necessary to
				assure that all relevant documentation is promptly obtained. The eligibility
				worker shall assist in obtaining verification documentation if the applicant
				requests help. The applicant shall cooperate fully consistent with his or her
				rights including confidentiality and consent.
(b) The eligibility worker shall explain to
				the applicant that children up to the age of 18 and children up to the age of
				19 if they are full-time students in a secondary school, or in the equivalent
				level of vocational or technical training, and reasonably expected to complete
				the program before reaching age 19 are eligible for AFDC-related Medicaid.
				Program completion is defined as the day of ceremonial graduation.
(c) The relationship between adoptive parent
				and child(ren) in AFDC-related Medicaid is as follows:
1. The eligibility worker shall explain to
				the applicant that in order to apply for AFDC-related Medicaid, he or she shall
				be either the natural or adoptive parent or eligible to serve as a
				parent-person of the eligible child(ren). An applicant who is a parent-person
				has the option of applying either for the child(ren), him or herself as a needy
				parent-person, or for the entire household. The advantages and disadvantages of
				each option shall be thoroughly discussed.
2. The eligibility worker shall explain that
				for the AFDC-F segment, the child(ren) shall be the natural or adoptive child
				of the two parents who are applying.
3. If not eligible for AFDC-related Medicaid,
				eligibility for any Medicaid program shall be explored.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.9 - Deprivation of parental support in AFCD-C-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Deprivation under AFDC-C-related Medicaid can result from death, incapacity or
				continued absence of one or both natural or adoptive parents.
(b) The eligibility worker shall inform the
				applicant of the need to prove the death of the eligible child(ren)'s parent(s)
				and of the sources available for such documentation (see
				10:69-3.3 ).
(c) Physical or mental incapacity of a parent
				shall be deemed to exist when both parents are in the home and one has a
				physical or mental defect, illness, or impairment. The incapacity shall be
				supported by competent medical testimony and must be of such a nature as to
				reduce substantially or eliminate the parent's ability to support or care for
				the eligible child and be expected to last for at least 30 days.
1. Evidence of incapacity without need for
				further development includes:
i. The
				applicant is receiving benefits not due to age alone under the Supplemental
				Security Income program (SSI) administered by the Social Security
				Administration (SSA);
ii. The
				applicant is receiving Social Security disability insurance benefits as the
				Federal RSDI program administered by the Social Security Administration;
				or
iii. The applicant is receiving
				inpatient care in a medical facility and the attending physician indicates in
				writing that such care shall be required for at least 30 days.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.10 - Ineligible family members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to
				those persons who are already not considered to be members of the eligible
				unit, the following persons shall also not be eligible for Medicaid and shall
				not be considered to be members of the eligible unit:
1. A person who is fleeing to avoid
				prosecution, custody or confinement after conviction, under the laws of the
				jurisdiction from which the person has fled, for a crime or an attempt to
				commit a crime which is a felony or a high misdemeanor under the laws of the
				jurisdiction from which the person has fled; or, is violating a condition of
				probation or parole imposed under Federal or State law;
2. A person found to have willfully and
				knowingly fraudulently misrepresented his or her residence in order to obtain
				means-tested public benefits in two or more states or jurisdictions, shall be
				ineligible for benefits for a period of 10 years from the date of conviction in
				a Federal or state court; or
3.
				Other aliens who are not eligible aliens as defined in
				N.J.A.C.
				10:69-3.9.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.11 - Residence requirement

Current through Register Vol. 56, No. 14, July 15, 2024
An applicant for or beneficiary of AFDC-related Medicaid
				  shall reside in New Jersey. Application for benefits should be made to CWA in
				  the county of residence.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.12 - Support from relatives

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The eligibility
				worker shall explain to applicant(s) that certain relatives must be contacted
				and evaluated to determine what capacity, if any, they have to contribute to
				the family's support. (See
				N.J.A.C.
				10:69-3.31 for enumeration of relatives
				responsible in each program) Eligibility for AFDC-related Medicaid shall not be
				delayed pending evaluation of legally responsible relatives.
(b) Applicants shall be advised that their
				entitlement to AFDC-related Medicaid shall not be jeopardized by the
				unwillingness of legally responsible relatives to provide support.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.13 - Repayment (all segments)

Current through Register Vol. 56, No. 14, July 15, 2024
The eligibility worker shall determine from the applicant
				  whether there is a pending claim against any individual, group, or agency on
				  behalf of any member of the eligible unit. If such a non-exempt claim does
				  exist, the applicant shall be advised that the completion of the application
				  form authorizes the CWA or the DMAHS to seek recovery of paid medical expenses
				  from any recovery received for medical expenses for treatment of a medical
				  condition.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.14 - Administrative action on application

Current through Register Vol. 56, No. 14, July 15, 2024
The eligibility worker shall review all appropriate forms
				  for completeness and accuracy, and give them to his or her supervisor. The
				  supervisor shall examine the forms for consistency of applicant's statements,
				  completion of all necessary information and correct income computations. If
				  acceptable, the supervisor shall indicate his or her approval by signing. If
				  not acceptable, the forms shall be returned to the eligibility worker for
				  correction.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.15 - Notice of approval, disapproval, and pending status and other information to client

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If immediate need is not apparent and a
				decision of approval or disapproval is not reached within 30 days of
				application, the CWA shall notify the applicant in writing of this fact and the
				reason for the delay. If the lack of decision is due to circumstances within
				the control and knowledge of the applicant, the CWA shall remind the applicant
				of the steps he or she must take to enable the CWA to make a decision. This
				notice shall include a sentence in Spanish cautioning the client that it
				relates to his or her eligibility for AFDC-related Medicaid and if he or she
				does not understand the notice he or she should contact the CWA. Translations
				to languages other than Spanish may be prepared based on knowledge of the
				population served by the CWA.
(b)
				When a decision is reached, the applicant shall be notified in writing of this
				decision (approved or disapproved).
(c) If the application is denied, the notice
				of disapproval shall meet the requirements in N.J.A.C. 10:69-6. In addition,
				for an applicant whose application has been denied for any reason other than
				death, the notification shall include:
1. An
				explicit statement of the reason for ineligibility;
2. Information about requesting a fair
				hearing to appeal the decision;
3.
				Advice concerning the family's right to reapply whenever they believe that
				their circumstances have changed such that the stated reasons for ineligibility
				no longer exist; and
4. Information
				about the Supplemental Nutrition Assistance Program (SNAP) and other
				potentially available services.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.16 - Withdrawal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The agency
				shall officially recognize the applicant's action through written notification
				within five working days of the applicant's request for withdrawal.
(b) This notification shall include a
				statement that the applicant's decision has been recognized and recorded by the
				agency, that no further action is being taken on his or her application, and a
				reminder that he or she has the right to reapply at any time.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.17 - Dismissal of application when client cannot be located

Current through Register Vol. 56, No. 14, July 15, 2024
When it is necessary to dismiss an application because an
				  applicant cannot be located, a notice shall be sent to the person's last known
				  address.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.18 - Verification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Verification of facts essential to
				eligibility is required in all segments of the AFDC-related Medicaid program
				(see N.J.A.C. 10:69-3.2 through 3.7).
				The eligibility worker shall verify all income.
1. The CWA shall try to verify all necessary
				information within the required time but shall not penalize the client if the
				CWA, through no fault of the client, is unable to obtain
				documentation.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 2 - THE APPLICATION PROCESS › Section 10:69-2.19 - Use of PA-1C as an application request

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Individuals who were admitted to a hospital and were subsequently referred to
				the CWA through the use of Form PA-1C, AFDC-related Medicaid Inquiry, may be
				eligible for AFDC-related Medicaid benefits from the date the PA-1C was
				completed, provided:
1. Such individual was
				an inpatient at the time the referral was made;
2. Except for good cause, including, but not
				limited to, hospitalizations lasting for three or more months, the homebound
				status of the applicant, the CWA was unable to schedule a timely application
				appointment, or the hospital failed to inform the applicant to apply at the
				CWA, the individual applies for AFDC-related Medicaid benefits within three
				months after the referral is made.
i. If the
				CWA determines that the individual had good cause for not applying within three
				months, an extension may be granted for an additional three months.
ii. Newborns of eligible women are deemed to
				have applied and shall be added to the Medicaid case, effective the date of
				birth, upon notifying the CWA of the birth.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.1 - Establishing eligibility for AFDC-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter
				presents in detail the program eligibility factors that must be considered in
				making determinations related to the AFDC-C and-F segments.
(b) A decision regarding eligibility shall be
				made within 30 days of application.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.2 - Documentation and recording of program eligibility requirements

Current through Register Vol. 56, No. 14, July 15, 2024
Fundamental to the establishment of eligibility for
				  AFDC-related Medicaid is the documentation of eligibility requirements.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.3 - Sources of evidence regarding eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Applicants and beneficiaries are in all instances the primary source of
				information about themselves and their families. It is the responsibility of
				the agency to determine eligibility and, as necessary, to secure verification
				from secondary sources. Such verification information shall be limited to those
				facts that are essential to establish eligibility and shall be obtained only
				with the consent of the client. It shall be explained to the client that
				verification is necessary and lack of consent to obtain it shall make
				processing of the application eligibility impossible.
(b) The client's statements regarding his or
				her eligibility are evidence. For purposes of AFDC-related Medicaid, the
				client's statements must be consistent and certain facts must be documented.
				The applicant shall be informed that the CWA needs to document the facts
				regarding certain eligibility criteria and that this process shall include
				contacting collateral sources as necessary:
1. Public records are preferred evidence and
				investigation of these sources shall be exhausted before other sources are
				used.
2. Sources of collateral
				evidence to establish eligibility include, but are not limited to, the
				following: birth, death and marriage certificates, church records, immigration
				and naturalization papers, census records, school records, military service
				records, court records, employment records, records of public or private
				welfare agencies, voting records, medical records, personal records, tax
				records, and affidavits from knowledgeable persons.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.4 - Verification of income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All
				beneficiaries of AFDC-related Medicaid must meet the criteria for financial
				need.
(b) Earned and unearned
				income verification is as follows:
1. The
				eligibility worker shall verify, either through examination of pay stubs or
				with the client's employer, the amount of gross earned income.
2. All unearned income shall be verified by
				examination of benefit check or by contact with the company or agency granting
				such benefit. Social Security benefit information verification may be
				accomplished through the Automated Benefit Information Exchange (ABIE)/
				Beneficiary and Earnings Data Exchange (BENDEX) and/or State Verification and
				Exchange System (SVES) (see
				10:69-8.2 concerning
				SVES).
3. Previous sources of
				support shall be explored with the applicant.
4. Legally responsible relatives shall be
				contacted for evaluation of their capacity to support (see
				10:69-5.9 ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.5 - Recording of documentation

Current through Register Vol. 56, No. 14, July 15, 2024
All information, written or oral, including sources and
				  methods of documentation, shall be recorded on Form PA-1J, Application and
				  Affidavit for AFDC-related Medicaid and included in the case record. See
				  10:69-7.3 concerning documentation
				  procedures.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.6 - Issuance of summons or subpoena

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When all other
				means of determining facts and circumstances concerning an application for
				assistance has been exhausted, the CWA director may:
1. Issue a subpoena to a third party in the
				State who has necessary and relevant information and require that pertinent
				records and other documents be produced for examination; and
2. Administer oaths for the purpose of such
				examinations.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.7 - Eligible unit

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The eligible
				unit shall be comprised of those family members who apply for and are eligible
				to receive AFDC-related Medicaid. It shall include one or more eligible
				children unless such child is a beneficiary of SSI or is excluded from the
				eligible unit in accordance with (c) below.
1. The eligible unit for AFDC-C or -F shall
				include any blood-related or adoptive brothers and sisters living in the same
				household and who are otherwise eligible for AFDC-C or -F. This requirement
				does not apply to stepbrothers or stepsisters.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.8 - Applicant and eligible unit AFDC-C and-F

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The term
				applicant in AFDC-C refers to the parent(s) or parent-person(s) who makes an
				affirmative decision to apply for Medicaid or, when the applicant is
				incapacitated or alleged incompetent, someone acting responsibly for him or her
				in order to maintain and provide for one or more dependent children of eligible
				age who are in his or her care or custody (see
				N.J.A.C.
				10:69-2.4(b)1 ). It may also
				include the stepparent, at the applicant's option, if the marriage meets the
				qualifications of
				N.J.A.C.
				10:69-10.33. If the AFDC-C-related Medicaid
				beneficiary parent marries a non-needy individual on or after October 1, 1992,
				the AFDC-C beneficiary natural or adoptive parent, the stepparent and that
				stepparent's own natural or adoptive child(ren) as well as the natural or
				adoptive AFDC-C beneficiary parent shall be excluded from the eligible unit.
1. When the applicant applying for AFDC-C
				based on continued absence of a natural or adoptive parent is himself or
				herself a natural or adoptive parent, he or she must apply for himself or
				herself and children of eligible age, unless such parent is an SSI beneficiary
				in which case he or she may apply for the eligible children only (see
				10:69-3.7 ).
2. When the applicant in AFDC-C is a
				parent-person, he or she has the option of applying for himself or herself and
				the eligible children or only for the eligible children in his or her care and
				custody.
3. In all AFDC-C cases, an
				application shall be signed by the adult member(s) or parent-minor (see
				10:69-3.11(a)  )
				of the unit for which AFDC-related Medicaid coverage is requested.
4. When the AFDC-C child(ren) lives with a
				parent-person(s), the application shall be executed by the parent-person who
				shall be the designated payee.
i. A pregnant
				woman under age 21 should be evaluated for eligibility for Medicaid Special
				under the criteria established in N.J.A.C. 10:69-12.
ii. A pregnant women who does not qualify for
				Medicaid Special should be evaluated against the eligibility criteria in
				N.J.A.C. 10:72. If the applicant meets all the eligibility requirements for the
				New Jersey Care ... Special Medicaid Programs requirements except for income,
				the application shall be referred to NJ FamilyCare -- Children's Program (see
				N.J.A.C. 10:79) for possible eligibility.
iii. Eligibility for AFDC-related Medicaid
				following the birth of the child is based on the requirements and standard for
				AFDC-C or-F, whichever is applicable.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.9 - AFDC-related Medicaid citizenship/eligibility requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In
				order to be eligible for the Medicaid program, an individual must be a citizen
				of the United States, or an alien lawfully admitted for permanent residence, or
				an alien approved for temporary residence who can be classified as an eligible
				alien in accordance with this chapter.
1. The
				term "citizen of the United States" includes persons born in Puerto Rico, Guam,
				the Virgin Islands, Swains Island, American Samoa, and the Northern Mariana
				Islands and children born to American citizens outside the U.S. and its
				outlying possessions pursuant to Section 301 of the Immigration and Nationality
				Act (
				8 U.S.C. §
											1401 ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.10 - Parent in AFDC-C and-F Medicaid segments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In
				AFDC-C, the term "parent" shall refer to the natural and/or adoptive parent(s)
				or parent-person(s).
1. By law, in AFDC-C
				certain relatives shall be recognized as taking the place of a parent. The term
				"parent-person" is used to designate one or more such relatives who include
				those of half-blood, those persons of preceding generations denoted by prefixes
				"grand" and "great," brother, sister, stepfather, stepmother, stepbrother,
				stepsister, uncle, aunt, first cousin, nephew, or niece. Such relative must be
				one with whom the dependent child is living, in a place of residence in New
				Jersey maintained by one or more such relatives as his or her or their own
				home.
i. A home is the family setting
				maintained or in process of being established as evidenced by assumption and
				continuation of responsibility for day to day care of the child by the relative
				with whom the child is living. A home exists so long as the relative exercises
				responsibility for the care and control of the child, even though either child
				or the relative is temporarily absent from the customary family
				setting.
ii. Health Benefit
				Identification (HBID) Cards and/or HBID Emergency Services Letters can be
				issued on behalf of child(ren) to persons authorized to act for specified
				relatives in emergency situations that deprive the child of the care of the
				relative through whom he or she has been receiving care, for a temporary period
				necessary to make and carry out plans for the child's continuing care and
				support.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.11 - Parent-minor in AFDC-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a
				parent-minor(s) and the parent-minor's child is residing with his or her
				natural or adoptive parent(s), income deeming rules apply to determining the
				eligibility of the parent-minor (see
				10:69-3.14 ).
(b) When a parent-minor(s) and the
				parent-minor's child reside with an adult relative other than their
				natural/adoptive parent(s), or as a separate household, the parent-minor's
				natural or adoptive parents shall be evaluated as legally responsible relatives
				in accordance with the provisions of
				10:69-3.10.
(c) When a parent-minor and his or her
				child(ren) are living in the home of the parent-minor's natural or adoptive
				parents, or relatives who qualify as parent-persons(s) of the parent-minor, and
				such parent(s) or parent-persons are themselves eligible for AFDC-related
				assistance, the eligible family shall consist of the parent-minor, the
				parent-minor's child, the parent-minor's parent(s) and the parent-minor's
				brothers and sisters.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.12 - Circumstances requiring special handling

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Circumstances requiring special handling which are not conditions of
				eligibility include the mental competency of applicant. Any person who applies
				for assistance shall be presumed to be mentally competent unless there is
				professional diagnostic evidence to the contrary, or unless there is question
				regarding competency because of certain observable behavior or
				reactions.
(b) Criteria for alleged
				incompetence of an applicant include:
1.
				Inability or substantial difficulty in giving simple identifying information
				such as his or her correct name, address, names of members of his or her
				family, names of persons with whom he or she lives or has frequent association
				(during the course of the interview references should be made to these
				previously directed questions and the consistency of the response noted);
				inability to report in a general way factual information about his or her
				economic status, his or her education, his or her employment history (if any),
				and his or her medical history; and
2. Insistence on relating irrelevant
				information in a way that appears genuinely unbalanced.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.13 - Age requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To be considered of eligible age, a child
				in AFDC-related Medicaid must be under age 18, or under age 19 and a full-time
				student in a secondary school, or in the equivalent level of vocational or
				technical training, and is reasonably expected to complete the program before
				reaching age 19. Program completion is defined as the day of ceremonial
				graduation. See
				N.J.A.C.
				10:69-10.9 for definitions regarding school
				attendance.
1. When any school or course of
				training involves attendance during an academic year, a child shall be
				considered eligible during the summer months when he or she has been accepted
				for admission in the fall. He or she shall be considered eligible during
				regular vacation periods unless the educational program has been completed or
				unless there is verification that the child does not attend or is not
				acceptable to reenter the program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.14 - Noneligible persons in the household

Current through Register Vol. 56, No. 14, July 15, 2024
When a noneligible individual is living in the household of
				  an eligible unit, a monthly amount shall be recognized as the cost standard for
				  that individual's share of household expenses (see
				  N.J.A.C.
				  10:69-10.27 ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.15 - Deprivation of parental support or care (AFDC-C)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				statutory definition of "dependent child" sets forth two eligibility factors:
				economic "need" and "deprivation of parental support or care." These two
				factors are not identical, and the law requires that both be demonstrated in
				each case.
(b) "Need" refers to
				financial eligibility and is determined in accordance with the provisions
				contained in this chapter.
(c)
				"Deprivation" is the result of death, physical or mental incapacity, or
				continued absence from the home of a natural or adoptive parent.
1. A child may be found to be deprived of
				parental support or care by reason of the documented death of either or both
				natural or adoptive parent(s).
2. A
				child may be found to be deprived of parental support or care by reason of the
				physical or mental incapacity of either or both natural or adoptive parent(s)
				whether such parent is in the home or is receiving treatment away from
				home.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.17 - Work criteria; determination of principal earner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to
				determine qualification for AFDC-F eligibility, a determination shall first be
				made as to which parent is the principal earner in that family.
1. The "principal earner" or primary wage
				earner is whichever parent earned the greater amount of income in the 24-month
				period immediately preceding the month of application for AFDC-F. This
				designation thereafter shall apply for each consecutive month for which the
				family receives AFDC-F.
2. When
				either parent can qualify as the principal earner because both parents earned
				an identical amount of income in such 24-month period, the principal earner
				shall be whichever parent earned the greater amount of income in the most
				recent consecutive six-month period of such 24-month period.
3. If both parents earned an identical amount
				of income in such six-month period, the CWA shall designate which parent shall
				be the principal earner.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.18 - Residence requirements

Current through Register Vol. 56, No. 14, July 15, 2024
The law requires that an applicant for or beneficiary of
				  assistance shall reside in New Jersey. Any person who responds affirmatively to
				  the question on the application "Do you plan to continue living in New Jersey?"
				  fulfills this requirement. The requirement is also satisfied when the person
				  resides in the State having entered with a job commitment or is seeking
				  employment even if he or she is currently unemployed.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.19 - Temporary absence from State

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A beneficiary
				family may leave the State for up to a one-month period with no resultant
				effect upon Medicaid eligibility. If absence from the State shall exceed or is
				anticipated to exceed the one-month period, the family shall immediately notify
				the CWA in order to request continuation of Medicaid for a three-month period
				following the month of departure, or any portion thereof. Such notice of intent
				to temporarily leave the State and request to continue Medicaid should be given
				to the CWA as far in advance of a planned absence as possible. Approval of such
				Medicaid continuation may be granted by the CWA quarterly for a period not to
				exceed one year. Authorization for extension of assistance beyond one year
				requires approval of the DMAHS.
(b)
				Upon establishment of the fact that the beneficiary family still considers its
				permanent residence to be New Jersey and that it plans to return thereto,
				continuation of Medicaid may be granted for the following reason(s):
1. Ill health;
2. Inability to travel of one or more
				members;
3. Mental or physical
				welfare; or
4. Family
				responsibility (for example, settling affairs of deceased).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.20 - Management of out-of-State case records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CWA
				shall maintain an up-to-date record of all cases of beneficiaries approved to
				receive Medicaid while out of the State.
(b) There shall be monthly supervisory review
				of the status of these cases to assure that the Health Benefits Identification
				(HBID) Card does not indicate active eligibility beyond the period for which
				approval has been given, unless and until extension of continued Medicaid
				coverage is approved.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.21 - Abandonment of State residence

Current through Register Vol. 56, No. 14, July 15, 2024
Medicaid coverage shall not be provided to beneficiaries who
				  abandon State residence by both terminating any actual place of abode in New
				  Jersey and establishing an actual place of abode in another state with apparent
				  intent to remain permanently absent from New Jersey. Abandonment shall also
				  encompass situations of prolonged absence from New Jersey for an indefinite
				  period for purpose other than temporary visit, and shall be reason for
				  termination of eligibility. Under circumstances delineated above, timely notice
				  need not be provided to the beneficiary, in accordance with
				  10:69-6.12(a).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.22 - Notice of termination

Current through Register Vol. 56, No. 14, July 15, 2024
Beneficiaries who are receiving AFDC-related Medicaid
				  coverage out-of-State shall be afforded the same full advance notice including
				  information about their right to a fair hearing in accordance with N.J.A.C.
				  10:69-6. A copy of any such notice shall be sent to any out-of-State agency
				  with which there has been communication regarding the case.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.23 - County residence for identification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Residence in a
				county is not an eligibility requirement. A county of residence is necessary to
				identify which CWA is legally responsible for receipt, registration, and
				processing an application and for issuance of a Health Benefits Identification
				(HBID) Card and/or HBID Emergency Services Letter, but shall not preclude or
				limit the opportunity for any person residing in New Jersey to apply for and
				receive Medicaid coverage without delay.
(b) Wherever a family is living shall be
				considered that family's county residence. When a beneficiary family, or any
				member thereof, goes to another county or state for the purpose of a temporary
				visit, that county or state shall not become the family's residence unless
				N.J.A.C.
				10:69-3.24 applies.
(c) A care facility or a public or private
				institution of custodial, curative, or penal character shall not be considered
				an individual's customary residence. Upon leaving such facility, the individual
				retains the same residence status that he or she had prior to admission. If the
				family moved during that individual's absence from the home, the county
				residence shall be that of the family.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.25 - Verification of residence

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Verification of
				residence is necessary to ensure eligibility. Under some circumstances,
				documentary evidence of residence may not be available.
1. The following are examples of sources of
				evidence of residence:
i. Landlord's records
				and rent receipts;
ii. Public
				utility records and receipts;
iii.
				Personal property assessment records;
iv. Census records;
v. Records of business or professional people
				such as grocers, bankers, and physicians with whom applicant has had frequent
				contact;
vi. Telephone
				directories;
vii. City directories
				if maintained on current basis;
viii. Postmarked letters addressed to
				applicant;
ix. Post office
				records;
x. School
				records;
xi. Records of social
				agencies, public or private;
xii.
				Employment records; or
xiii.
				Affidavits of knowledgeable persons that support other recorded evidence or
				knowledge of CWA.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.26 - Procedures governing release from State institutions

Current through Register Vol. 56, No. 14, July 15, 2024
The procedures provided in this subchapter have been
				  established specifically to govern relationships between the CWA and the
				  several State institutions. These procedures do not necessarily apply to
				  relationships with local mental hospitals and other institutions. When a CWA
				  develops other procedures to expedite release of persons from local
				  institutions, it shall submit complete plan material to the Division of Medical
				  Assistance and Health Services for approval prior to granting Medicaid coverage
				  to such persons.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.27 - Release from a State institution

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A parent or
				parent-person who is about to be released from an institutional facility
				(medical, mental, or correctional) may apply for AFDC-C related
				Medicaid.
(b) When eligibility has
				been established, benefits can begin upon release from the institution,
				providing the parent and child will be living together within 30 days of the
				date of issuance except in circumstances identified in (b)1 below. This
				application may be registered and processed up to two months before anticipated
				date of release.
1. When an applicant parent
				is being released from an institution for the mentally ill or intellectually
				disabled, or a correctional facility, no Health Benefits Identification (HBID)
				Card or HBID Emergency Services Letter shall be issued until the actual
				release, discharge, or parole is a matter of record and verified by the CWA,
				and the applicant is not adjudged or alleged to be mentally
				incompetent.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.28 - Temporary absence of a family member

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Eligibility for
				AFDC-related Medicaid may exist during the absence of a child, parent, or
				parent-person from the home under the circumstances described in
				N.J.A.C.
				10:69-3.29 and 3.30. When the absence is
				foreseeable, the CWA should make appropriate plans.
1. A parent or caretaker relative who fails
				to notify the CWA of the absence of the minor child from the home by the end of
				the five-day period that begins with the date that it becomes clear to the
				parent or relative that the minor child shall be absent for more than 180
				consecutive days shall be ineligible for benefits for a period of three months
				from the date the CWA becomes aware of the beneficiary's failure to notify the
				agency of the absence, which shall begin with the month following the month in
				which the absence becomes known.