N.J. Admin. Code § 10:72-4.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:72-4.1 - Income eligibility limits

(a) Income limits for Medicaid for aged, blind, and disabled persons (except for specified low-income Medicare beneficiaries), covered under the provisions of this chapter will be based on 100 percent of the poverty income guidelines as defined by the U.S. Department of Health and Human Services in accordance with sections 652 and 673(2) of the Omnibus Budget Reconciliation Act of 1981 ( Pub.L. 97-35). The monthly income standard will be 1/12 of the annual poverty income guideline rounded down to the next whole dollar amount for household unit sizes of one and two for aged, blind, and disabled individuals. The annual revision to the Federal poverty income guideline will be effective for purposes of this section with the first day of the year for which the poverty income guideline is promulgated.

(b) Effective with the first month of coverage, January 1, 1993, income limits for specified low-income Medicare beneficiaries shall be based on 110 percent of the poverty income guidelines as defined by the U.S. Department of Health and Human Services in accordance with Sections 1902(a)(10)(E)iii of the Social Security Act, 42 U.S.C. 1396 a. Effective January 1, 1995, the income limits will be set at 120 percent of the Federal poverty level.

(c) Income limits for pregnant women and children under the age of one year covered under the provisions of this chapter shall be based on 185 percent of the poverty income guideline as defined by the Department of Health and Human Services in accordance with sections 652 and 673(2) of the Omnibus Budget Reconciliation Act of 1981 ( Pub.L. 97-35). The monthly income standard will be one-twelfth of 185 percent of the annual poverty income guideline rounded down to the next whole dollar amount for each household size. The annual revision to the Federal poverty income guideline will be effective for the purposes of this section with the first day of the year for which the poverty guideline is promulgated.

(d) In order to be eligible for Medicaid benefits under the provisions of this chapter, monthly household income (as determined by this chapter) must be equal to or less than the income limit established in (a), (b) or (c) above as applicable.

1. If a pregnant woman is determined to be income eligible during any month prior to the end of her pregnancy, she, if otherwise eligible, will continue eligible without regard to changes in the household unit's income for the term of her pregnancy, including the 60-day period beginning with the last day of the pregnancy whether or not the pregnancy results in a live birth. If the income change results from the addition of a new household member, the new income is not considered through the 60-day period beginning with the last day of the pregnancy.

i. The child resulting from the pregnancy will be eligible for Medicaid 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 Medicaid, or would remain eligible if pregnant, and the child remains in the mother's custody.

ii. A pregnant woman who, during the course of the pregnancy, was receiving or would have been eligible to receive AFDC benefits using the eligibility rules in existence as of July 16, 1996. Medicaid Special, or Medicaid for the Unborn is deemed to have met the income requirements of this chapter.

2. With the exception in (d)1 above, income eligibility exists for each month in which the household unit's income is equal to or less than the income limits.

(e) Effective with the first month of coverage, earned income eligibility limits for participants in the NJ WorkAbility program shall be 250 percent or less of the Federal poverty level and unearned income 100 percent or less of the Federal poverty level (see 42 U.S.C. § 9902(2)) , and as specified in 10:72-9.4.

N.J. Admin. Code § 10:72-4.1

Emergency Amendment, R.1988 d.96, effective 2/2/1988 (expired April 2, 1988).
See: 20 N.J.R. 548(a).
Added (b)1ii.
Adopted Concurrent Proposal, R.1988 d.212, effective 5/16/1988.
See: 20 N.J.R. 548(a), 20 N.J.R. 1103(a).
Emergency Amendment, R.1991 d.223, effective 3/28/1991 (operative April 1, 1991; expires May 27, 1991).
See: 23 N.J.R. 1200(a).
Adopted Federally required coverage pursuant to Omnibus Budget Reconciliation Act of 1989.
Adopted Concurrent Proposal, R.1991 d.302, effective 5/24/1991.
See: 23 N.J.R. 1200(a), 23 N.J.R. 1945(a).
Provisions of emergency amendment R.1991 d.223 readopted without change.
Emergency Amendment, R.1991 d.445, effective 7/29/1991 (expires September 27, 1991).
See: 23 N.J.R. 2543(a).
In (b): added "aged one through five years" regarding children covered; added new (c), recodifying existing (c) as new (d).
Adopted Concurrent Proposal, R.1991 d.526, effective 10/21/1991.
See: 23 N.J.R. 2453(a), 23 N.J.R. 3144(a).
Provisions of emergency amendment R.1991 d.445 adopted without change.
Administrative Correction to (b).
See: 24 N.J.R. 851(a).
Added "133 percent of" to text regarding the poverty income guideline.
Amended by R.1992 d.364, effective 9/21/1992.
See: 24 N.J.R. 2145(a), 24 N.J.R. 3343(a).
Child's eligibility for Medicaid extended.
Amended by R.1992 d.484, effective 12/7/1992.
See: 24 N.J.R. 1860(a), 24 N.J.R. 4378(a).
Revised (a).
Amended by R.1993 d.369, effective 7/19/1993.
See: 25 N.J.R. 1042(b), 25 N.J.R. 3217(a).
Public Notice: Increase in eligibility limits.
See: 29 N.J.R. 3088(a).
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
In (a), deleted "as well as children six years of age or older" following "beneficiaries," in the first sentence, and deleted "and for the appropriate family size for children aged six years or over" at the end of the second sentence; deleted former (c); recodified former (d) as (c); and recodified former (e) as (d), deleted a reference to (d) in the introductory paragraph, rewrote 1ii, and substituted a reference to (d)1 for a reference to (e)1 in 2.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Special amendment, R.2002 d.31, effective 12/26/2001 (to expire June 26, 2002).
See: 34 N.J.R. 600(a).
Added (e).
Amended by R.2002 d.317, effective 9/16/2002.
See: 34 N.J.R. 600(a), 34 N.J.R. 1402(a), 34 N.J.R. 3270(a).
Public Notice: Annual Federal Poverty Level Revisions.
See: 36 N.J.R. 2564(a).