New Jersey Administrative Code

(a) The first $ 50.00 of any child support payments received on behalf of a dependent child or children by any family applying for or eligible for AFDC-related Medicaid program shall be disregarded. Such child support payments shall include disregarded child support (DCS) payment…

(a) Prospective budgeting policy shall be applied to applicants and beneficiaries of AFDC-related Medicaid program benefits, including Medicaid Special. (b) AFDC-related Medicaid program eligibility shall be based on a best estimate of the family's income and other circumstances …

(a) In determining initial eligibility, the appropriate disregards shall be applied to earned income. (b) The effective date of initial eligibility shall be the first day of the month of the date of the application if the client was eligible on the date of application. If the cli…

(a) For purposes of AFDC-related Medicaid program, in family groups living together, income of the spouse is considered available for the other spouse and income of a parent (natural or adoptive) is considered available for children under 18. If the spouse or parent is living wit…

(a) An adult sanctioned for failure to cooperate with the child support and paternity requirements is not included in the eligible unit. When the adult is not included in the eligible unit because of this sanction and has earned or unearned income of his or her own, such income s…

When an institutionalized child is on temporary visit home (and an AFDC-related Medicaid program eligible case is not in existence), he or she may be eligible for General Assistance if the visit does not exceed 21 consecutive days. If the length of such child's visit is expected …

(a) AFDC-related Medicaid program eligibility shall not exist for any month if the total income of the eligible unit exceeds the amount indicated in this subsection for the appropriate eligible unit size. For this purpose, total income shall include all income of the eligible uni…

(a) On all new applications, reapplications, or reopened applications, initial financial eligibility must be established before an HBID Card can be issued. 1. For AFDC-C- and F-related Medicaid cases, when the eligible family received AFDC-related Medicaid program assistance in o…

(a) The procedures regarding initial income eligibility are: 1. Identify the number of persons in the eligible unit; and 2. Determine the total monthly income (including gross earned income) available to the eligible unit and compare it to the maximum income level in N.J.A.C. 10:…

§ 10:69-10.32 - Reserved Notes N.J. Admin. Code § 10:69-10.32

(a) When a stepparent of eligible AFDC-C-related Medicaid program children is in fact a member of the household and has married the natural or adoptive beneficiary parent, the natural or adoptive parent who is applying for or receiving AFDC-related Medicaid program shall be affor…

§ 10:69-10.34 - Reserved Notes N.J. Admin. Code § 10:69-10.34

(a) A child not meeting AFDC-related Medicaid age requirements but who is under age 21, may be eligible for Medicaid Special if he or she would be otherwise eligible for AFDC-C or -F except for age (see N.J.A.C. 10:69-4). (b) Medicaid eligibility does not exist in cases where, af…

(a) An eligible unit may include some members eligible for AFDC-C-related Medicaid and others eligible for AFDC-F-related Medicaid. These combinations are called companion cases. (b) Companion cases shall have a common case number. (c) The AFDC-related Medicaid eligibility income…

Earnings payable under the terms of a renewable contract, for example, earnings of school teachers, are to be prorated over the stated term of the contract only. Notes N.J. Admin. Code § 10:69-10.37

When a member of the eligible unit receives a lump sum payment for services rendered over a period of more than a month, any disregard of earned income is to be computed for each month in which such income was earned. Notes N.J. Admin. Code § 10:69-10.38

(a) The CWA shall determine what contribution, whether in cash or kind, the relative is currently contributing or is willing to contribute toward the support of the eligibility unit. 1. Only the amount of support, whether in cash or in kind, actually being received by the eligibl…

(a) The eligible unit shall be comprised of those family members who apply for and are eligible to receive AFDC-related Medicaid program. It shall include one or more eligible children unless such child is a related Medicaid program beneficiary of SSI benefits. 1. The eligible un…

(a) The LRR's capacity to support shall be based on his or her total gross monthly income, including all income of whatever kind and from whatever source except as stated in this section. (b) Income determination rules are as follows:1. "Gross income" means income before deductio…

(a) Two sets of standards provide the basis for evaluation of an LRR's capacity to contribute to the support of the eligible unit: 1. Schedule IV-Part A applies to any natural or adoptive parent of eligible AFDC-related Medicaid children who is not a member of the eligible unit (…

(a) The LRR may fulfill his or her obligation to support the person or persons for whom he or she is responsible by contributing one or more of the following: 1. Cash; 2. Shelter and household needs; and/or 3. Any other item determined to be mutually satisfactory to the client an…

(a) The income of an alien's sponsor shall be deemed to be unearned income of an alien applying for AFDC-related Medicaid. Deeming continues until the earlier of naturalization of the immigrant or the immigrant's being credited with 40 quarters of Social Security coverage. Such q…

(a) Pursuant to the Tax Reform Act of 1986 ( P.L. 99-514), which clarifies certain amendments of the Deficit Reduction Act of 1984 ( P.L. 98-369), an adolescent parent is an individual under the age of 18 and who is himself or herself a parent of a dependent child. (b) When an ad…

(a) The AFDC-C related Medicaid program shall include: 1. The natural or adoptive parent(s) of one or more of the eligible child(ren) unless the AFDC-C-related Medicaid program beneficiary parent marries on or after October 1, 1992, and is excluded from AFDC-related Medicaid prog…

Notes N.J. Admin. Code § 10:69-10.6 Repealed by R.2005 d.64, effective 2/22/2005. See: 36 New Jersey Register 3622(a), 37 New Jersey Register 646(a). Section was "Eligible unit; AFDC-N related Medicaid program".

(a) A member of the eligible unit who is temporarily in an institution in accordance with N.J.A.C. 10:69-3.29 shall continue to be regarded as an eligible member of that unit. (b) When the absence of an AFDC-related Medicaid program parent will continue for 30 days or longer, the…

(a) When an eligible child is a student regularly attending school, college or university, or regularly attending a course of vocational training designed to fit him or her for gainful employment, this child shall be included as a member of the eligible unit whether or not he or …

(a) A child eligible under the age requirements of N.J.A.C. 10:69-3.13 shall be considered a student regularly attending a school or training course when he or she is enrolled in and physically attending, as certified by the school or institute, a program of study or training lea…

(a) Individuals seeking benefits under the provisions of this chapter shall be determined eligible or ineligible without regard to the value of the household unit's resources. The eligibility determination agency shall inquire about the household unit's resources only in order to…

This subchapter describes presumptive eligibility for children up to the age of 19 who otherwise meet the eligibility requirements for AFDC-related Medicaid or Medicaid Special. The presumptive eligibility determination makes it possible for a child or the children to be covered …

All beneficiaries of presumptive eligibility for children who make an application for presumptive eligibility benefits for any Medicaid or NJ FamilyCare-Children's Program shall be limited to one continuous presumptive eligibility period during the year, which shall be counted fr…

(a) The period of presumptive eligibility shall begin on the date an approved presumptive eligibility entity determines that, based on information provided by the family or representative of the presumptive eligibility beneficiary, the child(ren) meet(s) the requirements and stan…

(a) A qualified presumptive eligibility entity shall be a New Jersey Medicaid provider and: 1. An acute care hospital; 2. A local health department; or 3. A Federally Qualified Health Center (FQHC). (b) An entity shall apply to the Division of Medical Assistance and Health Servic…

(a) From preliminary information provided by the child, if appropriate, a parent, guardian, caretaker relative, or sponsoring adult, the qualified presumptive eligibility entity shall determine if the child meets the eligibility criteria of this subchapter. The qualified presumpt…

(a) Upon receipt of a properly completed application from the approved presumptive eligibility determination entity, Division staff shall: 1. Assign a presumptive eligibility number; 2. Create an eligibility record on the Medicaid Eligibility File; 3. Issue a Health Benefits Iden…

(a) Upon receipt of the presumptive eligibility application from the qualified presumptive eligibility determination entity, the CWA shall check the Medicaid, Medically Needy, and NJ FamilyCare -- Children's Program Eligibility database for existing eligibility. If the child is r…

The child, if appropriate, parent, guardian, or caretaker of a presumptively eligible child shall contact the CWA during the presumptive eligibility period so that a face-to-face interview can be scheduled. As part of the eligibility determination process for AFDC-related Medicai…

(a) For a presumptively eligible child who is subsequently determined ineligible for AFDC-related Medicaid benefits, Medicaid Special benefits, or any other Medicaid or NJ FamilyCare -- Children's Program benefits program, the CWA: 1. Shall not be required to provide either timel…

All AFDC-related Medicaid or Medicaid Special beneficiaries shall be entitled to receive fee-for-service during the presumptive eligibility period all the regular Medicaid services defined at N.J.A.C. 10:49-5.2. Notes N.J. Admin. Code § 10:69-12.9

(a) Any person who believes he or she and his or her children are eligible for AFDC-related Medicaid shall be given the opportunity to apply without delay. Applicants shall be informed by the CWA about the eligibility requirements and their rights and obligations in applying for …

(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, custo…

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. Notes N.J. Admin. Code § 10:69-2.11 Amended by 49 N.J.R. 3729(a), effective 12/4/2017

(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) …

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 appli…

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 computatio…

(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 contro…

(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 …