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

Universal Citation: NJ Admin Code 10:69-12.4

Current through Register Vol. 56, No. 6, March 18, 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:

1. Complete and sign the one-page presumptive eligibility (PE) application and forward the original of the application to the Division of Medical Assistance and Health Services within two working days of the date the presumptive eligibility determination was made;

2. Forward a copy of the completed application and a referral, if appropriate, to the CWA of the child's county of residence;

3. Inform the child, if appropriate, parent, guardian, caretaker relative, or sponsoring adult that they must contact the CWA in order to set up an appointment to complete the application process for AFDC-related Medicaid or Medicaid Special benefits;

4. Give the child, if the child has completed the application for presumptive eligibility, parent, guardian, caretaker relative, or sponsoring adult of the presumptively eligible child a copy of both the application and any referral; and

5. Advise the child, if the child has completed the application for presumptive eligibility, parent, guardian, caretaker relative, or sponsoring adult of the presumptively eligible child, in writing, of the address and telephone number of the appropriate CWA.

(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.

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