Current through Register Vol. 56, No. 18, September 16, 2024
(a) Eligibility
for the Medically Needy Program is limited to groups of persons within two
specified eligibility categories. An individual must meet the definition of one
of the categories below to be eligible for the Medically Needy
Program.
(b) The following
eligibility groups are within the AFDC-related eligibility category:
1. Pregnant women: Needy pregnant women of
any age during the term of a medically verified pregnancy, through the end of
the month during which the 60th day from delivery occurs.
i. A child born to a woman eligible as a
pregnant woman under the provisions of this chapter shall remain eligible for a
period not less than 60 days from his or her birth, and up to one year so long
as the mother remains eligible for Medicaid, or would remain eligible if
pregnant, whether or not application has been made, if the child lives with his
or her mother.
2.
Children under the age of 21: Needy children under the age of 21.
i. Children under the age of 21 may be
eligible regardless of: Parental deprivation; school attendance; emancipation;
residence with parent(s) or other caretaker relative(s); or Work Incentive
program (WIN) or other AFDC employment or training requirements.
ii. A child may be eligible for program
benefits when temporarily absent from his or her family in accordance with the
provisions of
10:69-3.28 through 3.30.
(c) The following
eligibility groups are within the SSI-related eligibility category:
1. Aged: Needy persons who are 65 years of
age or older.
2. Blind: Needy
persons who are statutorily blind. Statutory blindness is central visual acuity
of 20/200 or less in the better eye with the use of correcting lens. An eye
which has a limitation in the field of vision so that the widest diameter of
the visual field subtends at an angle no greater than 20 degrees is considered
to have a central visual acuity of 20/200 or less.
i. Persons who are receiving Social Security
disability benefits as a result of blindness are presumed to be blind for
purposes of this program.
ii.
Except for persons described in (c)2i above, the determination of statutory
blindness is the responsibility of the Division of Medical Assistance and
Health Services, Disability Review Section.
3. Disabled: Needy persons who are disabled.
Disability is the inability to do any substantial gainful activity by reason of
any medically determinable physical or mental impairment which can be expected
to result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months. The severity of impairment must
be such that the individual is unable to do his or her previous work or any
other substantial gainful activity which exists in the national economy. In the
determination of a person's ability to do any other work, residual functional
capacity, age, education, and work experience are considered.
i. Disability for children under the age of
18 is any medically determinable physical or mental impairment which compares
in severity to an impairment that would make an adult disabled.
ii. Persons who are receiving Social Security
disability benefits are presumed to be disabled for purposes of this
program.
iii. Except for persons
described in (c)3ii above, the determination of disability is the
responsibility of the Division of Medical Assistance and Health Services,
Disability Review Section.
(d) Under certain circumstances, an
individual may be considered for eligibility under both the SSI-related and
AFDC-related categories (for example, a blind child under the age of 21). Such
an individual may select the category under which he or she wishes to be
considered for program eligibility upon being advised by the county board of
social services of the option and the consequences thereof.
