New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 69 - AFDC-RELATED MEDICAID
Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN
Section 10:69-12.4 - Presumptive eligibility processing performed by the presumptive eligibility determination entity
Current through Register Vol. 56, No. 18, September 16, 2024
(a) From preliminary information provided by the child, if appropriate, a parent, guardian, caretaker relative, or sponsoring adult, the qualified presumptive eligibility entity shall determine if the child meets the eligibility criteria of this subchapter. The qualified presumptive eligibility entity shall obtain sufficient information from the child, if appropriate, parent, guardian, caretaker relative, or sponsoring adult by having the child, if appropriate, parent, guardian, caretaker relative, or sponsoring adult to complete the one-page presumptive eligibility (PE) application. For purposes of the presumptive eligibility determination, the approved presumptive eligibility entity shall request from the child, if appropriate, parent, guardian, caretaker relative, or sponsoring adult only that information necessary to determine the child's presumptive eligibility or ineligibility. The approved presumptive eligibility determination entity shall make the determination of eligibility based solely on information obtained in the interview and shall not require any verification or documentation of the presumptive eligibility applicant's statements.
(b) For any child determined presumptively eligible, the approved presumptive eligibility determination entity shall:
(c) For any child for whom the approved presumptive eligibility determination entity is unable to determine presumptive eligibility, or who is ineligible under the criteria and standards of this subchapter or any other Division rules that apply to children, the approved presumptive eligibility determination entity shall refer the child to the appropriate eligibility determination agency for evaluation of potential eligibility for any other Medicaid or NJ FamilyCare -- Children's Program entitlement. The address and telephone number of the appropriate eligibility determination agency shall be provided, in writing, to the child, if appropriate, parent, guardian, caretaker relative, or sponsoring adult of the child.