New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 71 - MEDICAID ONLY
Subchapter 2 - THE APPLICATION PROCESS
Section 10:71-2.1 - Definitions

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise:

"Application process" means all activity performed by the Income Maintenance Section relating to a request for medical assistance payments. The application process is primarily geared toward the determination of basic eligibility. However, since intake by its very nature involves a combination of services and income maintenance functions, a service worker shall be available as required during such process.

"Applicant," in Medicaid Only, means the aged, disabled or blind individual or his/her authorized agent who executes the formal written application (PA-1G).

"Approved" means that the applicant has been determined to be eligible for Medicaid Only.

"County welfare agency (CWA)" means that agency of county government, that is charged with the responsibility for determining eligibility for public assistance programs, including AFDC-Related Medicaid, Temporary Assistance to Needy Families (TANF), the Food Stamp Program, NJ FamilyCare and Medicaid. Depending on the county, the CWA might be identified as the board of social services, the welfare board, the division of welfare or the division of social services.

"Department of Human Services (DHS)" means the New Jersey Department of Human Services.

"Disposition of the application" means the official determination of the CWA that one of the following actions is appropriate: approval or rejection as defined in the section.

"DRA" means the Federal Deficit Reduction Act of 2005, P.L. 109-171.

"MRT" means Medical Review Team.

"New application" means a written request for assistance from an individual or his/her agent who has never previously requested assistance in any county in the State under the Medicaid Only program.

"Pending application" means the general term for application, reapplication, reopened application or transfer application prior to official disposition.

"Poverty guidelines" means, with respect to a household, the income poverty line as prescribed and revised at least annually pursuant to 42 U.S.C. § 9902(2). The poverty guidelines are a simplified version of the Federal Government's statistical poverty thresholds used by the Census Bureau to prepare its statistical estimates of the number of persons and families in poverty. The poverty guidelines issued by the Department of Health and Human Services pursuant to 42 U.S.C. § 9902(2) are used for administrative purposes, for example, for determining whether a person or family is financially eligible for assistance or services under a particular Federal program.

"Reapplication" means a written request for assistance by the individual whose previous application was rejected in any county in the State and who requests reconsideration of his/her current eligibility for Medicaid Only.

"Registration" means the action of the CWA in assigning a control number to an application.

"Rejected" is an inclusive term (for statistical purposes) for the following actions:

1. Denied means that the applicant has been determined to be ineligible for assistance for a specific reason.

2. Dismissed means official recognition that eligibility need not be considered further because:

i. The applicant died (however, if there were unpaid medical bills incurred subsequent to inquiry or application, whichever occurred first, the application process is to be completed); or

ii. The applicant cannot be located; or

iii. The application was registered in error; or

iv. The applicant moved to another county in New Jersey during the application process.

3. Withdrawn means that the applicant decided not to pursue the application further.

"Reopened application" means a written request by a former beneficiary in any county in the State for reconsideration of his or her current eligibility for the program.

"State Verification Exchange System (SVES)" means the Social Security Administration's database, which provides states with a standardized method of Social Security number verification and uniform data response.

"Transfer application" means a written request for assistance by the individual who at the time of registration is still receiving assistance through the CWA of another county from which he or she moved.