New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 78 - NJ FAMILYCARE › Subchapter 3 - NONFINANCIAL ELIGIBILITY › Section 10:78-3.4 - Beneficiaries

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as
				specified in (b) through (d) below, the following persons who meet all the
				eligibility criteria of this chapter and are not eligible to receive Medicaid
				or NJ FamilyCare Children's Program coverage under current provisions shall be
				eligible for NJ FamilyCare benefits:
1.
				Parents and caretakers of dependent children under the age of 19 whose gross
				family income does not exceed 200 percent of the Federal Poverty level (see
				N.J.A.C. 10:78-4 ), who applied as such for NJ FamilyCare benefits prior to
				June 15, 2002, and continuously have received those benefits;
2. Single adults or couples without dependent
				children whose gross family income does not exceed 100 percent of the Federal
				Poverty level (see N.J.A.C. 10:78-4 ) who applied as such for NJ FamilyCare
				benefits prior to September 1, 2001, and continuously have received those
				benefits.
i. A couple shall be defined as a
				man and a woman who are legally married, or who have been determined to be a
				couple by the Social Security Administration, or who are living together in the
				same household and presenting themselves to the community in which they live as
				husband and wife;
3.
				Pregnant women of any age during the term of a medically verified pregnancy
				whose gross family income does not exceed 200 percent of the Federal Poverty
				level.
i. A pregnant woman who is determined
				eligible under the criteria of this chapter shall, for purposes of eligibility,
				be considered to be a pregnant woman until the end of the 60-day period
				beginning with the last day of her pregnancy. Her eligibility as a pregnant
				woman shall end on the last day of the month in which the 60-day period
				ends;
4. Individuals
				under the age of 21 lawfully admitted for permanent residence and who qualify
				under the provisions in N.J.A.C. 10:69 or 10:79 but for Federal immigration
				residency restrictions;
5. Any
				child born to a woman eligible under the provisions of this chapter (except to
				a presumptively eligible pregnant woman who has subsequently been found
				ineligible for the month the child was born) shall remain eligible for a period
				of not less than 60 days from his or her birth and up to one year, so long as
				the mother remains eligible for NJ FamilyCare, or would remain eligible if
				pregnant, whether or not application has been made, if the child lives with his
				or her mother.
i. Notwithstanding (a)5 above,
				any child resulting from the pregnancy shall be eligible for NJ FamilyCare, if
				not otherwise eligible for Medicaid or the NJ FamilyCare Children's Program,
				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 NJ FamilyCare, or would remain eligible if pregnant, and the child
				remains in the mother's custody;
6. Parents, or caretakers, of dependent
				children under the age of 19 who meet the eligibility criteria contained in
				(a)6i through iv below and in this chapter, and who either were enrolled for
				benefits in the NJ FamilyCare Program on or after September 1, 2005, and
				continuously have received those benefits or have a pending application for
				such benefits that was received on or before February 28, 2010. The gross
				family income standards for eligibility of such individuals follows:
i. Effective September 1, 2005, parents, or
				caretakers, of dependent children under the age of 19 whose gross family income
				does not exceed 100 percent of the Federal Poverty Level;
ii. Effective September 1, 2006, parents, or
				caretakers, of dependent children under the age of 19 whose gross family income
				does not exceed 115 percent of the Federal Poverty Level;
iii. Effective September 1, 2007, parents, or
				caretakers, of dependent children under the age of 19 whose gross family income
				does not exceed 133 percent of the Federal Poverty Level; and
iv. Effective September 1, 2008, and applying
				to NJ FamilyCare existing enrollments under this paragraph and applications
				received by February 28, 2010, parents or caretakers of dependent children
				under the age of 19 whose gross family income does not exceed 200 percent of
				the Federal Poverty Level; and
7. Any individual receiving NJ FamilyCare
				under the provisions of this chapter who is receiving inpatient services
				covered by NJ FamilyCare shall continue to be eligible for FamilyCare until the
				end of the stay for which the inpatient services are furnished, notwithstanding
				any other provision of this chapter.