Current through Register Vol. 56, No. 18, September 16, 2024
(a) In order to
be eligible for the Medically Needy program, an individual must be a citizen of
the United States, an alien who has been lawfully admitted for permanent
residence for the five years prior to the application or an alien who can be
classified as an eligible alien in accordance with this subchapter.
1. The term "citizen of the United States"
includes person born in Puerto Rico, Guam, the Virgin Islands, Swains Island,
American Samoa, and the Northern Mariana Islands.
2. An individual who cannot be classified as
an eligible alien in accordance with this subchapter due to changes mandated by
the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (
Public Law
104-193) but who was residing in a
Medicaid-certified nursing facility prior to January 29, 1997, shall continue
to be eligible for medical assistance until the individual is no longer
eligible for long-term care services.
(b) The following aliens, if present in the
United States prior to August 22, 1996, and if otherwise meeting the
eligibility criteria, are entitled to Medically Needy benefits:
1. An alien lawfully admitted for permanent
residence;
2. A refugee admitted
pursuant to section 207 of the Immigration and Nationality Act;
3. An asylee admitted pursuant to section 208
of the Immigration and Nationality Act;
4. An alien whose deportation has been
withheld pursuant to section 243(h) of the Immigration and Nationality
Act;
5. An alien who has been
granted parole for at least one year by the Immigration and Naturalization
Service pursuant to section 212(d)(5) of the Immigration and Nationality
Act;
6. An alien who has been
granted conditional entry pursuant to section 203(a)(7) of the immigration law
in effect prior to April 1, 1980;
7. An alien who is granted status as a Cuban
or Haitian entrant pursuant to section 501(e) of the Refugee Education
Assistance Act of 1980;
8. An
American Indian born in Canada to whom the provisions of section 289 of the
Immigration and Nationality Act apply;
9. A member of an Indian tribe as defined in
section 4(e) of the Indian Self-Determination and Education Assistance
Act;
10. An alien who is admitted
to the United States as an Amerasian immigrant pursuant to section 584 of the
Foreign Operations, Export Financing, and Related Programs Appropriations Act
of 1988;
11. An alien who is
honorably discharged or who is on active duty in the United States Armed Forces
and his or her spouse and the unmarried dependent children of the alien or
spouse; and
12. Certain legal
aliens who are victims of domestic violence and when there is a substantial
connection between the battery or cruelty suffered by an alien and his or her
need for Medically Needy benefits, subject to certain conditions described
below:
i. The alien has been battered or
subjected to extreme cruelty in the United States by a spouse or a
parent;
ii. The alien has been
battered or subjected to extreme cruelty in the United States by a member of
the spouse's or parent's family residing in the same household of the alien and
the spouse or parent acquiesced to such battery or cruelty;
iii. The alien's child has been battered or
subjected to extreme cruelty in the United States by the spouse or the parent
of the alien (without the active participation of the alien in the battery or
cruelty);
iv. The alien's child has
been battered or subjected to extreme cruelty in the United States by a member
of the spouse's or parent's family residing in the same household as the alien
and the spouse or parent acquiesced to and the alien did not actively take part
in such battery or cruelty;
v. In
addition to the conditions described in (b)12i through iv above, if the
individual responsible for the battery or cruelty continues to reside in the
same household as the individual who was subjected to such battery or cruelty,
then the alien shall be ineligible for Medically Needy benefits;
vi. The county board of social services shall
apply the definitions "battery" and "extreme cruelty" and the standards for
determining whether a substantial connection exists between the battery or
cruelty and the need for Medicaid as issued by the Attorney General of the
United States under his or her sole and unreviewable discretion, in accordance
with 8 U.S.C. §
1641.
(c) The following aliens entering the United
States on or after August 22, 1996, and if otherwise meeting the eligibility
criteria of this chapter, shall be entitled to Medically Needy benefits:
1. An alien lawfully admitted for permanent
residence, but only after having been present in the United States for five
years;
2. A refugee admitted
pursuant to section 207 of the Immigration and Nationality Act;
3. An asylee admitted pursuant to section 208
of the Immigration and Nationality Act;
4. An alien whose deportation has been
withheld pursuant to section 243(h) of the Immigration and Nationality
Act;
5. An alien who has been
granted parole for at least one year by the Immigration and Naturalization
Service pursuant to section 212(d)(5) of the Immigration and Nationality Act
but only after the alien has been present in the United States for five
years;
6. An alien who has been
granted conditional entry pursuant to section 203(a)(7) of the immigration law
in effect prior to April 1, 1980 but only after the alien has been present in
the United States for five years;
7. An alien who is granted status as a Cuban
or Haitian entrant pursuant to section 501(e) of the Refugee Education
Assistance Act of 1980;
8. An
American Indian born in Canada to whom the provisions of section 289 of the
Immigration and Nationality Act apply;
9. A member of an Indian tribe as defined in
section 4(e) of the Indian Self-Determination and Education Assistance
Act;
10. An alien who is admitted
to the Untied States as an Amerasian immigrant pursuant to section 584 of the
Foreign Operations, Export Financing, and Related Programs Appropriations Act
of 1988;
11. An alien who is
honorably discharged or who is on active duty with the United States Armed
Forces and his or her spouse and the unmarried dependent children of the alien
or spouse; and
12. Certain aliens
who are victims of domestic violence as specified in (b)12 above, but only
after the alien has been present in the United States for five years.
(d) Any alien who is not an
eligible alien as specified in (b) and (c) above is ineligible for Medically
Needy benefits. Any such alien, if a resident of New Jersey and if he or she
meets all other Medically Needy eligibility requirements contained in this
chapter, is entitled to Medically Needy coverage for the treatment of an
emergency medical condition only. This coverage is limited to those emergency
services which would otherwise be covered by Medically Needy. This coverage
does not include inpatient hospital services.
1. An emergency medical condition is one of
sudden onset that manifests itself by acute symptoms of sufficient severity
(including severe pain) such that the absence of immediate medical attention
could reasonably be expected to result in:
i.
Placing the patient's health in serious jeopardy;
ii. Serious impairment to bodily functions;
or
iii. Serious dysfunction of any
bodily organ or part.
2.
An emergency medical condition shall include all labor and delivery for a
pregnant woman, but shall not include routine prenatal or routine post-partum
care.
3. Services related to an
organ transplant procedure are not covered under services available for
treatment of an emergency medical condition.
(e) Persons claiming to be citizens and
eligible aliens shall provide the county board of social services with
documentation of citizenship or alien status, in accordance with (f)
below.
(f) As a condition of
eligibility, all applicants for the Medically Needy program, (except those
applying solely for services related to the treatment of an emergency medical
condition or for services related to labor and delivery for pregnant women)
shall sign a declaration under penalty of perjury that they are a citizen of
the United States or an alien in a satisfactory immigration status. In the case
of a child or incompetent applicant, another individual on the applicant's
behalf shall complete the same written declaration under penalty of perjury.
1. The following are acceptable documentation
of United States citizenship:
i. A birth
certificate;
ii. A religious record
of birth recorded in the United States or its territories within three months
of birth. The document must show either the date of birth or the individual's
age at the time the record was created;
iii. A United States passport (not including
limited passports which are issued for periods of less than five
years);
iv. A Report of Birth
Abroad of a Citizen of the U.S. (Form FS-240);
v. A U.S. Citizen I.D. Card (INS Form-197),
Naturalization Certificate (INS Form N-550 or N-570);
vi. A Certificate of Citizenship (INS Forms
N-560 or N-561);
vii. A Northern
Mariana Identification Card (issued by the INS to a collectively naturalized
citizen of the United States who was born in the United States before November
3, 1986);
viii. An American Indian
Card with a classification code "KIC" (issued by the INS to identify U.S.
citizen members of the Texas Band of Kickapoos); or
ix. A contemporaneous hospital record of
birth in one of the 50 states, the District of Columbia, Puerto Rico (on or
after January 13, 1941), Guam (on or after April 10, 1899), the U.S. Virgin
Islands (on or after January 17, 1917), American Samoa, Swain's Island, or the
Northern Mariana Islands (unless the person was born to foreign diplomats
residing in any of these jurisdictions).
2. If an applicant presents an expired INS
document or is unable to present any document demonstrating his or her
immigration status, the county board of social services shall refer the
applicant to the local INS district office to obtain evidence of status. If,
however, the applicant provides an alien registration number, but no
documentation, the county board of social services shall file INS Form G-845
along with the alien registration number with the local INS district office to
verify status.
3. The following
shall constitute acceptable documentation for eligible aliens.
i. Lawful Permanent Resident--INS Form I-551,
or for recent arrivals, a temporary I-551 stamp in a foreign passport or on
Form I-94;
ii. Refugee--INS Form
I-94 annotated with stamp showing entry as refugee under section 207 of the
Immigration and Nationality Act and date entry into the United States; INS Form
I-688B annotated "274a. 12(a)(3)," I-766 annotated "A3," or I-571. Refugees
usually adjust to Lawful Permanent Resident status after 12 months in the
United States, but for purposes of determining Medically Needy eligibility,
they are considered refugees. Refugees whose status has been adjusted will have
INS Form I-551 annotated "RE-6," "RE-7," "RE-8," or "RE-9."
iii. Asylees--INS Form I-94 annotated with a
stamp showing grant of asylum under section 208 of the Immigration and
Nationality Act, a grant letter from the Asylum Office of the Immigration and
Naturalization Service, Form-688B annotated "274a.12(a)(5)," or I-766 annotated
"A5."
iv. Deportation
Withheld--Order of an Immigration Judge showing deportation withheld under
section 243(h) of the Immigration and Nationality Act and the date of the
grant, or INS Form I-688B annotated "274a. 12 (a)(10)" or I-766 annotated
"A10."
v. Parole for at Least a
Year--INS Form I-94 annotated with stamp showing grant of parole under section
212(d)(5) of the Immigration and Nationality Act and a date showing granting of
parole for at least a year.
vi.
Conditional Entry under Law in Effect before April 1, 1980--INS Form I-94 with
stamp showing admission under section 203(a)(7) of the Immigration and
Nationality Act, refugee-conditional entry, or INS Form I-688B annotated
"274a.12(a)(3)" or I-766 annotated "A3."
vii. Cuban Haitian Entrant--INS Form I-94
stamped "Cuban/Haitian Entrant" under section 212(d)(5) of the INA.
viii. An American Indian born in Canada--INS
Form I-551 with code S13 or an unexpired temporary I-551 stamp (with code S13)
in a Canadian passport or on Form I-94.
ix. A member of certain Federally recognized
Indian tribes--Membership card or other tribal document showing membership in
tribe.
x. Amerasian Immigrant--INS
Form I-551 with the code AM1, AM2, or AM3 or passport stamped with an unexpired
temporary I-551 showing a code AM6, AM7, or AM8.
4. For aliens subject to the five-year
waiting period before eligibility for Medically Needy can be established, the
date of entry into the United States shall be determined as follows:
i. On INS Form I-94, the date of admission
should be found on the refugee stamp. If missing, the county board of social
services should contact the INS local district office by filing Form G-845,
attaching a copy of the document;
ii. If the alien presents INS Form I-688B
(Employment Authorization Document), I-766, or I-571 (Refugee Travel Document),
the county board of social services shall ask the alien to present Form I-94.
If that form is not available, the county board of social services shall
contact the INS via the submission of Form G-845, attaching a copy of the
documentation presented;
iii. If
the alien presents a grant letter or court order, the date of entry shall be
derived from the date of the letter or court order. If missing, the county
board of social services shall contact the INS by submitting a Form G-845,
attaching a copy of the document presented.
5. For aliens who present themselves as on
active duty or honorably discharged from the United States Armed Forces, the
following serve as documentation:
i. For
discharge status, an original, or notarized copy of the veteran's discharge
papers issued by the branch of service in which the applicant was a
member;
ii. For active duty
military status, an original, or notarized copy, of the applicant's current
orders showing the individual is on full-time duty with the U.S. Army, Navy,
Air Force, Marine Corps., or Coast Guard (full-time National Guard duty does
not qualify), or a military identification card (DD Form 2 (active));
iii. A self declaration under penalty of
perjury may be accepted, pending receipt of acceptable documentation.