New Jersey Administrative Code

(a) Eligibility must be established in relation to each legal requirement to provide a valid basis for granting or denying medical assistance. (b) The applicant's statements regarding his/her eligibility, as set forth in the application form, are evidence. The statements must be …

For purposes of determining medical eligibility for the Medicaid Only program, the disability and blindness standards shall be the same as for the Supplemental Security Income program under Title XVI of the Social Security Act, as amended by Public Law 92-603. Notes N.J. Admin. C…

(a) The determination of disability and blindness eligibility for the Medicaid Only program is a direct responsibility of the Medical Review Team in the Division of Medical Assistance and Health Services. Determination of all other factors of eligibility is the responsibility of …

(a) An individual is disabled for purposes of this part if he/she is unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last fo…

(a) The CWA shall furnish the Medical Review Team with current, pertinent social and medical information, and obtain any special or additional reports on request. (b) When it appears that an applicant meets the income and resources requirements for Medicaid Only, arrangements for…

(a) Persons who are otherwise eligible for Medicaid Only receive medical coverage while receiving patient care in eligible medical institutions. Such coverage shall be provided through the appropriate payment mechanism of the Division of Medical Assistance and Health Services. Th…

(a) The CWA shall be responsible for determining income and resource eligibility, as outlined in N.J.A.C. 10:71-4 and 5, for Medicaid Only when the applicant is receiving care in institutions defined in N.J.A.C. 10:71-3.14(d). This does not include residents of the State psychiat…

(a) Medical Assistance Customer Centers: The Division of Medical Assistance and Health Services has local medical offices throughout the State, known as Medical Assistance Customer Centers (MACCs). The role of these MACCs is to: provide liaison with providers of health services; …

(a) The applicant must be a resident of the United States who is either a citizen or an alien who can be classified as an eligible alien in accordance with this subchapter. 1. An individual who cannot be classified as an eligible alien in accordance with this subchapter due to ch…

(a) A person born in the United States is, by definition, a United States citizen. The United States is defined as the Continental United States, Alaska, Hawaii, Puerto Rico, Guam and the Virgin Islands of the United States. Native-born persons of American Samoa, Swains Island an…

An applicant for or beneficiary of Medicaid Only shall be a resident of the State of New Jersey. Notes N.J. Admin. Code § 10:71-3.4 Amended by R.2000 d.415, effective 10/16/2000. See: 32 N.J.R. 2565(a), 32 N.J.R. 3844(a). Substituted "beneficiary" for "recipient".

(a) The term "resident" shall be interpreted to mean a person who is living in the State voluntarily and not for a temporary purpose, that is, with no intention of presently removing therefrom. (b) County residence is not an eligibility requirement and relates only to identificat…

(a) Responsibility for case management shall be transferred from one county to the other when a beneficiary moves to another county. (b) A temporary visit by the beneficiary shall not be considered to be a change of county residence until that visit has continued for more than a …

(a) Whenever a beneficiary wishes to leave New Jersey either to establish a permanent residence or for a temporary visit, he or she shall be advised of the effect of this plan on his or her eligibility for continued medical assistance. Particular care should be taken to advise th…

(a) Federal and State statute and regulations expressly bar a duration-of-residence requirement as a condition of eligibility. The New Jersey Medical Assistance and Health Services Act authorizes a grant of medical assistance to a qualified applicant who is a resident of the Stat…

(a) Age requirements are: 1. The applicant must be 65 years of age or older to be eligible based on age alone; 2. A disabled or blind child must be under 18 years of age, or under 22 years of age and a student regularly attending school and neither married nor the head of the hou…

(a) The resources criteria and eligibility standards of this section apply to all applicants and beneficiaries. (b) Resources defined: For the purpose of this program a resource shall be defined as any real or personal property which is owned by the applicant (or by those persons…

(a) The provisions of this section shall apply, effective June 18, 2001, only to persons who are receiving an institutional level of services, including individuals who are receiving services under a 42 U.S.C. § 1915(c) home and community care waiver under Medicaid, or who are se…

(a) For purposes of this subchapter, effective June 18, 2001, a trust is any legal instrument, device, or arrangement which is similar to a trust, in which a grantor transfers property to an individual or entity with fiduciary obligations (considered to be a trustee for purposes …

(a) Any resource which is not specifically excludable under the provisions of N.J.A.C. 10:71-4.4 shall be considered a countable resource for the purpose of determining Medicaid Only eligibility. 1. No portion of a cash reward offered by the Division to an individual for providin…

§ 10:71-4.3 - Reserved Notes N.J. Admin. Code § 10:71-4.3

(a) A resource which is classified as excludable shall not be considered either in the deeming of resources or in the determination of eligibility for participation in the Medicaid Only Program. (b) The following resources shall be classified as excludable: 1. A house occupied by…

(a) For eligibility in the Medicaid Only Program, total countable resources are subject to the following limits. (See N.J.A.C. 10:71-4.1(b) regarding definition of resources, N.J.A.C. 10:71-4.2 regarding countable resources, and N.J.A.C. 10:71-4.8 regarding resources of a couple …

(a) When an applicant/beneficiary is an adult residing in the same household with his or her ineligible spouse or is a child residing in the same household with his or her parent(s) or spouse of parent, the resources of the ineligible spouse or parent(s) is considered in the dete…

Notes N.J. Admin. Code § 10:71-4.7 R.1983 d.373, effective 9/6/1983. See: 15 N.J.R. 999(b), 15 N.J.R. 1477(a). Amended by R.1985 d.474, effective 9/16/1985. See: 17 N.J.R. 1525(a), 17 N.J.R. 2274(a). Other resources changed from "$ 600.00" to "$ 1,100" and the total changed from …

(a) In the determination of resource eligibility for an individual requiring long-term care, the county welfare agency shall establish the combined countable resources of a couple as of the first period of continuous institutionalization beginning on or after September 30, 1989. …

(a) At the beginning of the first continuous period of institutionalization (beginning on or after September 30, 1989), the institutionalized spouse or the community spouse (or a representative of either spouse) may request an assessment of the couple's total countable resources.…

(a) As a condition of eligibility for the Medicaid Only Program, applicants must comply with the income standards set forth in this subchapter (see N.J.A.C. 10:71-5.6). (b) Income defined: For the purpose of this program, income shall be defined as receipt, by the individual, of …

(a) Countable income shall be determined by adding the applicant's nonexempt unearned income (less appropriate exclusions) to his/her earned income (less appropriate exclusions). (b) Procedures regarding the determination of income eligibility shall be as follows: 1. Determinatio…

(a) Only the following income shall be excluded in the determination of countable income. Income exclusions shall be applied to unearned income first, then to earned income as appropriate. Exclusions shall be applied in the order of their appearance in this section. 1. Monies rec…

(a) Any income which is not specifically excluded under the provisions of N.J.A.C. 10:71-5.3 shall be includable in the determination of countable income. Such income shall include, but is not limited to, the following: 1. Wages, salaries, tips, and commissions: Any and all compe…

(a) When an applicant/beneficiary is an adult residing in the same household with his or her ineligible spouse or is a child residing in the same household with his or her parent(s) or spouse of the parent, the income of the ineligible spouse or parent(s) is considered in the det…

(a) Table B which follows shall be used to determine income eligibility for aged, blind, and disabled persons who make application for Medicaid Only benefits. The standard used for applicants/beneficiaries shall be determined in accordance with the following living arrangement ca…

(a) The amounts specified in (b) through (h) below shall be deducted from the income of an institutionalized individual prior to the application of his or her income to the cost of the long-term care. These deductions apply only after the individual is determined eligible for Med…

(a) In a contractual agreement where the individual has transferred his available assets to the facility in exchange for full medical care in the institution, the institution has a legal responsibility to provide such care and Medicaid benefits are not payable for the institution…

(a) For the purposes of determining eligibility for Medicaid Only for a legal alien (applying for the first time on or after October 1, 1980), the income and resources (see N.J.A.C. 10:71-4.10) of any person who sponsored the alien's entry into the United States will be deemed to…

The case record is a complete record in support of the CWA's decisions and actions for each case. Notes N.J. Admin. Code § 10:71-6.1 Amended by R.1995 d.651, effective 12/18/1995. See: 27 N.J.R. 3543(a), 27 N.J.R. 5046(a). Amended by R.2000 d.415, effective 10/16/2000. See: 32 N.…

(a) The following items shall be included in the case record: 1. The narrative recording; 2. All medical reports and record of action from the MRT (appropriate cases); 3. All forms related to financial eligibility; and 4. All related correspondence, memoranda and documents except…

Forms applicable to the Medicaid Only program (aged, blind and disabled) are listed on page 1 of Appendix A; sample forms follow that list. Notes N.J. Admin. Code § 10:71-6.3

All case record material relevant to each family shall be maintained under an appropriate registration number. All records shall be appropriately indexed and filed. Notes N.J. Admin. Code § 10:71-6.4

(a) No case record or official part of such record shall be removed from its designated filing cabinet without an identifying record of the person who has custody of it. (b) No case record or official part shall be removed from the offices of the county welfare board except at th…

For the policy and procedure on retention and destruction of case records see N.J.A.C. 10:69-7, Case Records and Files. Notes N.J. Admin. Code § 10:71-6.6 Amended by R.2000 d.415, effective 10/16/2000. See: 32 N.J.R. 2565(a), 32 N.J.R. 3844(a). Substituted "N.J.A.C. 10:69" for "P…

Medicaid Only beneficiaries, like Supplemental Security Income (SSI) beneficiaries, are eligible to receive services and related service payments for services identified at N.J.A.C. 10:71-7.2 and for payment of burial and funeral expenses as authorized by N.J.A.C. 10:71-7.5. Such…

Eligible applicants and beneficiaries as defined under the State Plan for Title XX of the Social Security Act may receive the services and related service payments specified in the State Plan. The Division of Youth and Family Services is responsible for providing the county welfa…

Eligible applicants and beneficiaries of Medicaid Only are also eligible to receive certain service payments as authorized at N.J.A.C. 10:69-10.22(b) and 10.23. These include payments for expenses incident to homemaker service, travel costs for health care, and childcare in certa…

Eligible applicants and beneficiaries of Medicaid Only are not eligible to receive emergency assistance as defined in N.J.A.C. 10:69-10.23. Notes N.J. Admin. Code § 10:71-7.4 Amended by R.2000 d.415, effective 10/16/2000. See: 32 New Jersey Register 2565(a), 32 New Jersey Registe…

The county welfare agency is directed, under certain situations, to provide payments for burial and funeral expenses on behalf of Supplemental Security Income and adult "Medicaid Only" beneficiaries, as well as former Old Age Assistance, Disability Assistance and Assistance for t…