New Jersey Administrative Code

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. Notes N.J. Admin. Code § 10:69-2.17

(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 t…

(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 in…

(a) The application process begins with an individual's initial contact with the agency and ends with a decision by the CWA as to the eligibility for AFDC-related Medicaid. Both the applicant and the eligibility worker have an affirmative responsibility in verifying and documenti…

(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 gene…

(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 …

(a) Official registration of an application shall include: 1. Entry in an application register under appropriate classification; and 2. Assignment of a registration number. (b) Registration shall be completed on the same day application is made, or, if application is made outside…

(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 depriv…

The eligibility worker shall determine financial eligibility (need) of the eligible family members by Form 105, if appropriate, in accordance with this subchapter. Notes N.J. Admin. Code § 10:69-2.7

(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 s…

(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 …

(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. Notes N.J. Admin. Code § 10:69-3.1 Amend…

(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 incl…

(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 N.J.A.C. 10:69-3.14). (b) When a parent-minor(s) and the parent-minor's child resi…

(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 u…

(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 re…

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). Notes N.J. Admin. Code § 10:69-3.14 Amended by 49 N.J.R. 3729(a), …

(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 el…

(a) The CWA shall make every reasonable effort to locate an absent parent in order to obtain support payments. An absent parent shall be given the opportunity to voluntarily support his or her child, but it shall be explained to both parents that the extent of support shall be es…

(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 …

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 wh…

(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 c…

Fundamental to the establishment of eligibility for AFDC-related Medicaid is the documentation of eligibility requirements. Notes N.J. Admin. Code § 10:69-3.2

(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 ind…

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. Abandonme…

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 ag…

(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 Emerg…

(a) Responsibility for AFDC-related Medicaid, and Medicaid extension case management and payment, shall be transferred from one county to the other when a beneficiary family moves to another county. (b) A temporary visit by either the beneficiary family or any member thereof shal…

(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 recor…

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 deve…

(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…

(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 care…

(a) When a child who would be otherwise eligible for AFDC-related Medicaid is out of the home due to voluntary/involuntary placement in an institution, he or she shall be recognized as a member of the eligible unit so long as it is anticipated that he or she will return home with…

(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 informa…

(a) Temporary absence of a child that has not lasted more than 30 consecutive days does not affect eligibility. When the absence of a child lasts longer than 30 days or it appears that an absence will last longer than 30 days, the CWA shall review the situation. 1. If it is found…

(a) Certain relatives are legally considered responsible to provide support if financially able and may be a source of income for an AFDC-related Medicaid applicant or beneficiary. The CWA shall determine the capacity of LRRs to contribute to the support of AFDC-related Medicaid …

(a) The CWA director has authority, after due investigation, to direct a legally responsible relative to pay toward the support of an applicant for or beneficiary of AFDC-related Medicaid. (b) Upon failure of such relative to comply, the director shall so certify in writing to th…

Notes N.J. Admin. Code § 10:69-3.33 Special repeal, R.2000 d.411, effective 9/12/2000 (to expire March 12, 2001). See: 32 New Jersey Register 3598(a). Section was "Assignment or transfer of property". Adopted concurrent repeal R.2001 d.123, effective 3/12/2001. See: 32 New Jersey…

(a) Members of the eligible family shall take all necessary and reasonable action to avail themselves of funds for support from others who owe or may owe money to them or who are holding funds for them. Any funds made available by such action shall be considered as income to the …

(a) The CWA shall, in all circumstances, take appropriate action to recover all AFDC-related Medicaid improperly granted. The action taken shall be in accordance with the appropriate sections of this chapter, N.J.A.C. 10:49, and any other applicable authority. 1. Recoveries of fu…

(a) Upon voluntary liquidation of a claim or interest, and the family is currently receiving AFDC-related Medicaid, the CWA shall evaluate the situation to determine the family's continued eligibility for Medicaid coverage. (b) Rules on continued eligibility arising from sale of …

Notes N.J. Admin. Code § 10:69-3.37 Special repeal, R.2000 d.411, effective 9/12/2000 (to expire March 12, 2001). See: 32 New Jersey Register 3598(a). Section was "Liquidation of nonexempt real property". Adopted concurrent repeal R.2001 d.123, effective 3/12/2001. See: 32 New Je…

(a) AFDC-related Medicaid benefits shall not be payable for any month in which any caretaker relative with whom the child is living, is, on the last day of such month, participating in a strike. Additionally, no individual's needs shall be included in determining the amount of AF…

(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 e…

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 N.J.A.C. 10:69-7.3 concerning documentation procedures. Notes N.J. Admin. Co…

(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 o…

(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) …

(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 …

(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 chapt…

(a) An individual under age 21, who would not have qualified as a dependent child for AFDC-related Medicaid, whether or not he or she lives with his or her parent(s), may be eligible for Medicaid Special. (b) When the individual lives in the same household as his or her birth or …