New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 74 - MANAGED HEALTH CARE SERVICES FOR MEDICAID/NJ FAMILYCARE BENEFICIARIES
Subchapter 8 - ENROLLEES
Section 10:74-8.2 - Enrollment exclusions

1. Individuals who are institutionalized in an inpatient psychiatric institution, a long term care nursing facility, or an inpatient psychiatric program for children under the age of 21 or in a residential facility including intermediate care facilities for individuals with intellectual disabilities (ICF/IID) with the following exception:

2. Individuals in the Medically Needy, Presumptive Eligibility for pregnant women, presumptive eligibility for children under the Medicaid/NJ FamilyCare programs, or the PACE Program;

3. Infants of inmates of a public institution living in a prison nursery;

4. Individuals in out-of-State placements;

5. Full-time students attending school and residing out of the country while in school; and

6. The following types of dual beneficiaries: Qualified Medicare Beneficiaries not otherwise eligible for Medicaid, Special Low-Income Medicare Beneficiaries (SLMBs), Qualified Disabled and Working Individuals (QDWIs), and Qualifying Individuals 1 and 2 (QIs 1 and 2).