Current through Register Vol. 56, No. 18, September 16, 2024
(a) The
eligibility determination agency shall verify all factors related to
eligibility for the NJ FamilyCare program. Factors subject to verification
include:
1. Birth date: The birth date of any
person for whom benefits are sought shall be provided; if there is a
discrepancy between the age reported by the applicant and the age appearing on
the program record and the discrepancy affects eligibility or categorical
requirements then the applicant shall be required to submit proof of birth
date;
2. Citizenship/Immigration
status: The immigration status of any individual seeking benefits who is not a
citizen of the United States shall be verified to establish entitlement for NJ
FamilyCare benefits;
3. Household
composition: The eligibility determination agency shall verify the household
composition in order to ascertain which persons will be included in the
determination of eligibility for NJ FamilyCare benefits;
4. Social Security number: The Social
Security number of any person seeking NJ FamilyCare benefits shall be provided
and verification shall be required when other information indicates a
discrepancy regarding the Social Security number;
5. Eligibility for, or coverage under, other
health insurance; and
6. All
sources of income of any person whose income shall be counted in the
determination of program eligibility.
i. To
verify income, a new applicant shall submit one recent pay stub from each
employer of each household member.
ii. If a household member cannot provide a
recent pay stub, the household member may submit another form of income
verification as the Division allows, such as a letter from his or her employer,
on the employer's letterhead.
iii.
If the applicant fails to submit income verification in a timely manner, before
determining the applicant ineligible for the NJ FamilyCare program, the
Division shall seek to verify the household's income by reviewing available
records from the Department of Treasury or Department of Labor and Workforce
Development concerning the household members, or such other records as the
Division allows.
iv. Although
resources are not a factor of eligibility, resources shall be identified and
verified to determine if income is derived from the resources.
(b) The eligibility
determination agency shall use documentary evidence as the primary source of
verification. Documentary evidence is written confirmation of the family's
circumstances. The applicant shall obtain or assist the eligibility
determination agency in obtaining any required documentation.
(c) In circumstances in which the documentary
evidence is questionable or is not available, the eligibility determination
agency may use collateral contact to confirm the family's circumstances. A
collateral contact is a person who provides verbal confirmation of a family's
circumstances by a person outside the family. In order to be acceptable as
verification, a collateral contact shall be in a position to provide accurate
information about the family and the circumstance in question.
(d) Subsequent to the initial application,
verification is required for only those factors of eligibility which are
subject to change or for those factors for which the original verification has
become questionable.
(e) In the
absence of credible verification of all eligibility factors, eligibility for
the NJ FamilyCare program shall not be established.
