New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 78 - NJ FAMILYCARE
Subchapter 1 - INTRODUCTION
Section 10:78-1.1 - Program outline

Universal Citation: NJ Admin Code 10:78-1.1

Current through Register Vol. 56, No. 18, September 16, 2024

(a) This chapter contains the criteria for NJ FamilyCare eligibility for certain uninsured parents, caretakers and caretaker relatives and children not eligible under the provisions of N.J.A.C. 10:69, AFDC-Related Medicaid, and 10:79, NJ FamilyCare Children's Program, as well as certain uninsured single individuals and couples without dependent children not eligible under the provisions of N.J.A.C. 10:90, Work First New Jersey Program. Prior to June 15, 2002, NJ FamilyCare also provided subsidized health insurance to those legal immigrants who were lawfully admitted for permanent residence and who met all other qualifications under the provisions of N.J.A.C. 10:69, 10:72 and 10:79, but for the Federal immigrant residency restrictions. After June 14, 2002, no applications were accepted from individuals who were parents, caretakers and caretaker relatives. As of September 1, 2005, the program was reopened to new applicants who were parents, or caretakers, of dependent children under the age of 19 and who meet the eligibility criteria contained in 10:78-3.4(a)6 and this chapter. For all applications received after February 28, 2010, all programs under this chapter are closed to any enrollments of, or benefits for, parents and caretakers whose benefits are not funded or payable under Title XIX of the Social Security Act. Therefore, such applications for such persons will not be processed for enrollment. Additionally, on and after April 1, 2010, applicants or beneficiaries who are adult restricted aliens, as defined at 10:78-3.2, are ineligible for enrollment in, or benefits from, the NJ FamilyCare Program and any other program under this chapter, except as allowed pursuant to 10:78-3.2(e)2; this termination of enrollments and benefits does not apply to individuals who are pregnant women or children under the age of 19.

(b) Individuals financially ineligible for Medicaid under the provisions of N.J.A.C. 10:71, 10:72 or 10:69 and who are income ineligible for FamilyCare under the provisions of this chapter shall be evaluated for eligibility as Medically Needy under the provisions of N.J.A.C. 10:70.

(c) Eligibility under the provisions of this chapter shall be limited to those individuals not otherwise eligible for Medicaid or NJ FamilyCare, including:

1. Parents and caretakers of children under the age of 19, as described and limited at 10:78-3.4;

2. Pregnant women whose income is over 185 percent, but does not exceed 200 percent, of the Federal poverty level (FPL);

3. Immigrant pregnant women lawfully admitted for permanent residence who would be eligible for Medicaid but for Federal immigrant residency restrictions;

4. Single individuals and couples without dependent children; and

5. Children under the age of 21.

(d) Persons found eligible for NJ FamilyCare will receive services as set forth in 10:78-7.1, Scope of services.

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