N.J. Admin. Code § 10:78-2.3

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

Section 10:78-2.3 - Verification requirements

(a) The eligibility determination agency shall verify all factors related to eligibility for the NJ FamilyCare program. Factors subject to verification include:

1. Birth date: The birth date of any person for whom benefits are sought shall be provided; if there is a discrepancy between the age reported by the applicant and the age appearing on the program record and the discrepancy affects eligibility or categorical requirements then the applicant shall be required to submit proof of birth date;

2. Citizenship/Immigration status: The immigration status of any individual seeking benefits who is not a citizen of the United States shall be verified to establish entitlement for NJ FamilyCare benefits;

3. Household composition: The eligibility determination agency shall verify the household composition in order to ascertain which persons will be included in the determination of eligibility for NJ FamilyCare benefits;

4. Social Security number: The Social Security number of any person seeking NJ FamilyCare benefits shall be provided and verification shall be required when other information indicates a discrepancy regarding the Social Security number;

5. Eligibility for, or coverage under, other health insurance; and

6. All sources of income of any person whose income shall be counted in the determination of program eligibility.

i. To verify income, a new applicant shall submit one recent pay stub from each employer of each household member.

ii. If a household member cannot provide a recent pay stub, the household member may submit another form of income verification as the Division allows, such as a letter from his or her employer, on the employer's letterhead.

iii. If the applicant fails to submit income verification in a timely manner, before determining the applicant ineligible for the NJ FamilyCare program, the Division shall seek to verify the household's income by reviewing available records from the Department of Treasury or Department of Labor and Workforce Development concerning the household members, or such other records as the Division allows.

iv. Although resources are not a factor of eligibility, resources shall be identified and verified to determine if income is derived from the resources.

(b) The eligibility determination agency shall use documentary evidence as the primary source of verification. Documentary evidence is written confirmation of the family's circumstances. The applicant shall obtain or assist the eligibility determination agency in obtaining any required documentation.

(c) In circumstances in which the documentary evidence is questionable or is not available, the eligibility determination agency may use collateral contact to confirm the family's circumstances. A collateral contact is a person who provides verbal confirmation of a family's circumstances by a person outside the family. In order to be acceptable as verification, a collateral contact shall be in a position to provide accurate information about the family and the circumstance in question.

(d) Subsequent to the initial application, verification is required for only those factors of eligibility which are subject to change or for those factors for which the original verification has become questionable.

(e) In the absence of credible verification of all eligibility factors, eligibility for the NJ FamilyCare program shall not be established.

N.J. Admin. Code § 10:78-2.3

Amended by R.2006 d.347, effective 10/2/2006.
See: 38 N.J.R. 2602(a), 38 N.J.R. 3095(a), 38 N.J.R. 4222(a).
Rewrote (a); in (b), substituted "The applicant shall obtain or assist" for "It is the responsibility of the applicant to obtain or to assist"; and in (c), inserted "person who provides".