New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 49 - ADMINISTRATION MANUAL
Subchapter 2 - NEW JERSEY MEDICAID BENEFICIARIES
Section 10:49-2.2 - Persons eligible under the New Jersey Medicaid program
Universal Citation: NJ Admin Code 10:49-2.2
Current through Register Vol. 56, No. 18, September 16, 2024
(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.
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