N.J. Admin. Code § 10:49-2.2

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

Section 10:49-2.2 - Persons eligible under the New Jersey Medicaid program

(a) The eligibility rules for persons eligible under the regular New Jersey Medicaid program are included in N.J.A.C. 10:69, 10:70, 10:71, 10:72, 10:78 and 10:79.

(b) The following groups may be eligible for medical and health services covered under the New Jersey Medicaid program requirements as outlined in the second chapter of each Provider Services Manual. The list is not all inclusive but is intended to provide an overview of some of the types of individuals who may be eligible for Medicaid benefits, when provided in accordance with the requirements of N.J.A.C. 10:69, 10:70, 10:71, 10:72, 10:78 and 10:79, as appropriate.

1. Persons who are eligible to receive Supplemental Security Income (SSI) payments as determined by the Social Security Administration and those persons who meet the SSI standards but apply for the Medicaid Only program through the CWA. Those persons are the aged (65 and over), the blind, and the disabled;

2. A person who qualifies under the Supplemental Security Income (SSI) program as the "ineligible spouse" of an SSI beneficiary determined by the Social Security Administration;

3. For a period of one year, a child born to a woman who is a Medicaid beneficiary, so long as the woman remains eligible for Medicaid, or would remain eligible if pregnant;

4. Persons for whom adoption assistance agreements are in effect pursuant to Section 473 of the Social Security Act ( 42 U.S.C. § 673 ) or for whom foster or adoption assistance is paid under Title IV-E of the Act;

5. Persons ineligible for Supplemental Security Income (SSI) because of requirements that do not apply under Medicaid;

6. Persons receiving only mandatory State supplemental payments administered by the Social Security Administration;

7. Certain former beneficiaries of Supplemental Security Income (SSI) who would still be eligible for SSI except for entitlement to or increase in the amount of Social Security benefits;

8. Persons eligible for but not receiving TANF or an optional State benefit;

9. Children under the age of 21 years who meet the income and resource requirements for TANF but do not qualify as dependent children;

10. Persons who are in institutions for at least 30 consecutive days and who are eligible under a special income level (the Medicaid "cap") that is higher than the income level for a noninstitutionalized SSI or State supplement beneficiary;

11. Pregnant women and children up to the age of one whose income is below 185 percent of the Federal poverty level, and children up to the age of six whose income is below 133 percent of the Federal poverty level, codified as 42 U.S.C. § 1396a, or 1902(l) of the Social Security Act;

12. Aged, blind, and disabled persons whose income is below 100 percent of the Federal poverty level and whose assets are within 200 percent of the SSI asset limits;

13. For a period lasting through the end of the month following the 60th day following delivery, women who have applied for Medicaid benefits before the last day of pregnancy and who are eligible for Medicaid on the last day of pregnancy; and

14. Refugees who are eligible under the Refugee Resettlement program.

N.J. Admin. Code § 10:49-2.2

Amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
Inserted new (a); and recodified former (a) as (b) and amended.
Amended by R.2003 d.81 and 82, effective 2/18/2003.
See: 34 N.J.R. 2647(a), 2650(d), 35 N.J.R. 1116(a), 1118(a).
In (b), deleted "regular" preceding "New Jersey Medicaid program" and amended the N.J.A.C. references in the introductory paragraph, deleted 3 through 6 and 18 and recodified former 7 through 19 as 3 through 14.
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
In (b)1, substituted "CWA" for "CBOSS"; and in (b)11, inserted "of" preceding "one" and substituted "§1396a" for "§ 1396a".