N.J. Admin. Code § 10:70-1.1

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

Section 10:70-1.1 - Program scope

(a) The Medically Needy Program, enacted by P.L. 1985, Chapter 371, extends limited Medicaid program benefits to certain groups of medically needy persons whose income and/or resources exceeds the standards for the Medicaid program but are within the standards for the Medically Needy Program, or whose income exceeds the standards for the Medically Needy Program but is insufficient to meet their medical expenses as determined in this chapter.

(b) Eligibility for the Medically Needy Program is limited to the following eligibility groups within the family and adult eligibility categories:

1. AFDC-related:

i. Pregnant women; and

ii. Children under 21 years of age.

2. SSI-related:

i. Persons 65 years of age or older;

ii. Persons who are blind; and

iii. Persons who are disabled.

(c) The medical services covered under the Medically Needy Program are limited to eligibility group and by the spend-down provisions of N.J.A.C. 10:70-6. All restrictions and limitations on services applicable to the Medicaid program apply to services for the Medically Needy. The services covered under the Medically Needy Program (by eligibility group) are described in 10:49-5.3.

(d) Retroactive eligibility for the Medically Needy Program is available beginning with the third month prior to the month of application, if members of an eligibility group have incurred expenses for covered services within that period which have not yet been paid and the members would have been eligible for the Medically Needy coverage in the month in which the services were received. Members of the eligibility group need not be eligible for the program at the time of application in order to be eligible for retroactive eligibility. Application for retroactive eligibility may be made on behalf of a deceased person so long as the person was alive during a portion of the retroactive eligibility period and he or she incurred medical expenses for covered services.

1. Retroactive coverage is not available for any period prior to July 1, 1986, the effective date of the Medically Needy Program.

N.J. Admin. Code § 10:70-1.1

Amended by R.1996 d.263, effective 6/3/1996.
See: 28 N.J.R. 1463(a), 28 N.J.R. 3001(a).
Amended by R.2006 d.364, effective 10/16/2006.
See: 38 N.J.R. 2368(a), 38 N.J.R. 4480(c).
In (c), substituted "N.J.A.C. 10:70-" for "subchapter" and updated N.J.A.C. reference at end.