New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL
Subchapter 7 - PRESUMPTIVE ELIGIBILITY FOR CHILDREN
Section 10:72-7.4 - Policies governing the presumptive eligibility processing performed by the presumptive eligibility determination entity
Current through Register Vol. 56, No. 6, March 18, 2024
(a) From preliminary information provided by a parent, guardian, or caretaker relative, the approved presumptive eligibility entity shall determine if the child meets the eligibility criteria of this subchapter as it applies to children. The approving presumptive eligibility entity shall obtain sufficient information from the parent, guardian, or caretaker relative to complete the certificate of presumptive eligibility. For purposes of the presumptive eligibility determination, the approved presumptive eligibility determination entity shall request from the parent, guardian, or caretaker relative only that information necessary to determine the child's presumptive eligibility or ineligibility. The approved presumptive eligibility determination entity shall make the determination of eligibility based solely on information obtained in the interview and shall not require any verification or documentation of the presumptive eligibility beneficiary's statements.
(b) For any child determined presumptively eligible, the approved presumptive eligibility determination entity shall:
(c) For any child for whom the approved presumptive eligibility determination entity is unable to determine presumptive eligibility, or who is ineligible under the criteria and standards of this subchapter or any other Division rules applicable to children, the approved presumptive eligibility determination entity shall refer the child to the appropriate eligibility determination agency for evaluation of potential eligibility for any other Medicaid or NJ FamilyCare programs. The address and telephone number of the appropriate eligibility determination agency shall be provided, in writing, to the parent, guardian or caretaker relative of the child.