Current through Register Vol. 56, No. 18, September 16, 2024
(a) The
term applicant in AFDC-C refers to the parent(s) or parent-person(s) who makes
an affirmative decision to apply for Medicaid or, when the applicant is
incapacitated or alleged incompetent, someone acting responsibly for him or her
in order to maintain and provide for one or more dependent children of eligible
age who are in his or her care or custody (see
N.J.A.C.
10:69-2.4(b)1) . It may also
include the stepparent, at the applicant's option, if the marriage meets the
qualifications of
N.J.A.C.
10:69-10.33. If the AFDC-C-related Medicaid
beneficiary parent marries a non-needy individual on or after October 1, 1992,
the AFDC-C beneficiary natural or adoptive parent, the stepparent and that
stepparent's own natural or adoptive child(ren) as well as the natural or
adoptive AFDC-C beneficiary parent shall be excluded from the eligible unit.
1. When the applicant applying for AFDC-C
based on continued absence of a natural or adoptive parent is himself or
herself a natural or adoptive parent, he or she must apply for himself or
herself and children of eligible age, unless such parent is an SSI beneficiary
in which case he or she may apply for the eligible children only (see
10:69-3.7) .
2. When the applicant in AFDC-C is a
parent-person, he or she has the option of applying for himself or herself and
the eligible children or only for the eligible children in his or her care and
custody.
3. In all AFDC-C cases, an
application shall be signed by the adult member(s) or parent-minor (see
10:69-3.11(a) )
of the unit for which AFDC-related Medicaid coverage is requested.
4. When the AFDC-C child(ren) lives with a
parent-person(s), the application shall be executed by the parent-person who
shall be the designated payee.
i. A pregnant
woman under age 21 should be evaluated for eligibility for Medicaid Special
under the criteria established in N.J.A.C. 10:69-12.
ii. A pregnant women who does not qualify for
Medicaid Special should be evaluated against the eligibility criteria in
N.J.A.C. 10:72. If the applicant meets all the eligibility requirements for the
New Jersey Care ... Special Medicaid Programs requirements except for income,
the application shall be referred to NJ FamilyCare -- Children's Program (see
N.J.A.C. 10:79) for possible eligibility.
iii. Eligibility for AFDC-related Medicaid
following the birth of the child is based on the requirements and standard for
AFDC-C or-F, whichever is applicable.
(b) The term applicant in AFDC-F refers to
natural or adoptive parents, not incapacitated, both of whom shall be required
to execute the formal written application unless one such parent is not
available for reasons beyond the family's control. This parent shall be
required to sign as promptly as he or she is available for such purpose (see
N.J.A.C.
10:69-10.36 relevant to companion
cases).
(c) To be eligible for
AFDC-C, an individual shall be either a citizen of the United States or an
eligible alien. (See
N.J.A.C.
10:69-3.9 for alien status that may qualify
an individual for AFDC-related Medicaid.)
1.
Income of those ineligible individuals who are parents of otherwise eligible
children shall be considered available to the eligible family and shall be
calculated in accordance with the stepparent deeming formula at
N.J.A.C.
10:69-10.33.
2. Medicaid coverage through AFDC-related
Medicaid shall not be granted to an ineligible alien or to aliens admitted as
students or visitors. However, United States citizen/eligible alien children of
illegal aliens may still be able to receive AFDC-C- or AFDC-F-related Medicaid.
The situations described in (c)2i through iii below serve as illustrations of
how to determine AFDC-C or-F, status for U.S. citizen/eligible alien children
of ineligible aliens.
i. In the case of one
ineligible alien parent with U.S. citizen/eligible alien children, the children
shall be eligible for Medicaid as AFDC-C due to parental deprivation (one
parent is absent). The eligible unit shall consist of the U.S. citizen/eligible
alien children. There is no Medicaid eligibility for the ineligible alien
parent but his or her income shall be counted as available to the eligible unit
in accordance with N.J.A.C. 10:69-10.
ii. If one parent is an eligible alien or
U.S. citizen, and qualifies the children for Medicaid as AFDC-F segment, the
children and eligible alien/citizen parent shall be eligible for Medicaid under
the -F segment. The other parent's income shall be counted as available to the
eligible unit in accordance with N.J.A.C. 10:69-10 but he or she is ineligible
for Medicaid.
iii. If one or both
parents are not eligible aliens or U.S. citizens and the parents do not meet
the criteria to qualify the children for Medicaid under the AFDC-F segment, the
children may, if otherwise eligible, qualify for NJ FamilyCare Children's
Program coverage if they are U.S. citizens/eligible aliens.
