Current through Register Vol. 56, No. 18, September 16, 2024
(a) Extended
Medicaid benefits shall be provided to former AFDC-related Medicaid families in
accordance with the provisions of this section for a period of 24 months
beginning with the month in which the family no longer would have otherwise
been eligible for AFDC-related Medicaid due to an increase in earned income.
1. When an AFDC-C or-F family loses
eligibility for AFDC-related Medicaid due to the following reasons, Medicaid
eligibility continues for a period of 24 months beginning with the month in
which the family is no longer eligible for AFDC-related Medicaid:
i. Earnings or increased earnings from
employment, including earnings from new employment;
ii. Increased hours of employment;
or
iii. Receipt of New Jersey State
unemployment or temporary disability insurance benefits.
2. New members added to the eligible family
during the 24 month extension period, as appropriate, are not included under
the extended coverage, with the exception of a child born to the family during
the 24 month extension period. For children born during this period, the child
and the mother may be eligible for additional coverage if the 60-day
post-partum period continues beyond the termination of the extension period
applicable to the remainder of the household, or if the child's 12-month
guaranteed period of Medicaid eligibility continues beyond that termination
date. In either case, Medicaid eligibility terminates at the end of the
guaranteed eligibility period, if that termination date is later than the
termination date of the 24 month Medicaid extension.
3. Eligibility for the 24-month Medicaid
extension is not available for any month to any individual who, except for
income or hours of employment, is not otherwise eligible to receive
AFDC-related Medicaid. The following individuals shall not be included in the
eligible family for Medicaid extension:
i.
Any child who reaches the age of 18, or any child who is attending a secondary
or vocational school full-time up to the month of graduation or age 19, except
that such child shall be evaluated for Medicaid eligibility for other
appropriate Medicaid programs; and
ii. All other family members who are
receiving Medicaid extension solely because of the presence in the home of a
child who "ages out," as in (a)3i above.
4. When an AFDC-C related Medicaid family
loses eligibility as a result (wholly or in part) of the collection of child or
spousal support through the Child Support and Paternity process, AFDC-related
Medicaid eligibility continues for a period of four calendar months beginning
with the month in which such ineligibility begins.
i. In order to qualify for this extension of
Medicaid benefits, the family must have received and been eligible to receive
AFDC-C-related Medicaid in at least three of the six months immediately
preceding the month in which ineligibility for AFDC-related Medicaid
begins;
ii. Eligibility for this
extension shall be terminated for any child who reaches the age of 18, or any
child who is attending a secondary or vocational school full-time up to the
month of graduation or age 19, except that such child shall be evaluated for
Medicaid eligibility for other appropriate Medicaid programs; and
iii. All other family members who are
receiving Medicaid extension solely because of the presence in the home of a
child who "ages out," as described in (a)4ii above, shall be
terminated.
(b) Those cases that are in Medicaid
extension only shall also be transferred to the new county of residence when
the family moves from the county of origin in the same manner as active
AFDC-related Medicaid cases. The procedures established at
N.J.A.C.
10:69-3.24 are to be followed when
transferring a case in Medicaid extension.
(c) AFDC applicants may be eligible for
retroactive Medicaid benefits; such determinations are made by the CWA. The
eligibility worker shall ask if the family has unpaid medical bills from the
previous three months and shall provide the applicant with appropriate forms.
The CWA shall make a determination of eligibility for each of the three
previous months, based on the eligibility rules in this chapter.
(d) AFDC eligible families who would not have
received any AFDC payments solely because the amount payable would be less than
$ 10.00, are eligible for AFDC-related Medicaid benefits. Likewise, AFDC
families who would have been ineligible for AFDC solely because of rounding of
the amount that would otherwise be payable, are eligible for AFDC-related
Medicaid benefits.
(e) For newborns
of eligible women who have applied, before or on the date of the birth, and are
eligible for Medicaid on the date of birth, except for a presumptively eligible
pregnant woman, as defined at
N.J.A.C.
10:72-6.1, who is subsequently found
ineligible for the month the child was born, eligibility continues for both
mother and child through the last day of the month in which the 60-day
post-partum period ends, without regard to other program requirements. So long
as the mother remains eligible, or would remain eligible if pregnant, the child
remains eligible for Medicaid for a period of one year, whether or not
application has been made for the child.
(f) Individuals who were admitted to a
hospital and were subsequently referred to the CWA through the use of Form
PA-1C, Public Assistance Inquiry, may be eligible for Medicaid benefits from
the date the PA-1C was completed, provided:
1.
Such individual was an inpatient at the time the referral was made;
2. Except for good cause, including, but not
limited to, hospitalizations lasting for three or more months, the homebound
status of the applicant, the CWA was unable to schedule a timely application
appointment, or the hospital failed to inform the applicant to apply at the
CWA, the individual applies for AFDC-related Medicaid benefits within three
months after the referral is made.
i. If the
CWA determines that the individual had good cause for not applying within three
months, an extension may be granted for an additional three months.
ii. Newborns of eligible women are deemed to
have applied and shall be added to the Medicaid case, effective the date of
birth, upon receipt of a valid Form PA-1C (see
N.J.A.C.
10:69-2.19 for coverage limits).
(g) Those cases that
are in Medicaid extension only shall also be transferred to the new county of
residence when the family moves from the county of origin in the same manner as
active AFDC-related Medicaid cases. The procedures established at
N.J.A.C.
10:69-3.24 are to be followed when
transferring a case in Medicaid extension.
