Current through Register Vol. 56, No. 18, September 16, 2024
(a) Except as
specified in (b) through (d) below, the following persons who meet all the
eligibility criteria of this chapter and are not eligible to receive Medicaid
or NJ FamilyCare Children's Program coverage under current provisions shall be
eligible for NJ FamilyCare benefits:
1.
Parents and caretakers of dependent children under the age of 19 whose gross
family income does not exceed 200 percent of the Federal Poverty level (see
N.J.A.C. 10:78-4), who applied as such for NJ FamilyCare benefits prior to
June 15, 2002, and continuously have received those benefits;
2. Single adults or couples without dependent
children whose gross family income does not exceed 100 percent of the Federal
Poverty level (see N.J.A.C. 10:78-4) who applied as such for NJ FamilyCare
benefits prior to September 1, 2001, and continuously have received those
benefits.
i. A couple shall be defined as a
man and a woman who are legally married, or who have been determined to be a
couple by the Social Security Administration, or who are living together in the
same household and presenting themselves to the community in which they live as
husband and wife;
3.
Pregnant women of any age during the term of a medically verified pregnancy
whose gross family income does not exceed 200 percent of the Federal Poverty
level.
i. A pregnant woman who is determined
eligible under the criteria of this chapter shall, for purposes of eligibility,
be considered to be a pregnant woman until the end of the 60-day period
beginning with the last day of her pregnancy. Her eligibility as a pregnant
woman shall end on the last day of the month in which the 60-day period
ends;
4. Individuals
under the age of 21 lawfully admitted for permanent residence and who qualify
under the provisions in N.J.A.C. 10:69 or 10:79 but for Federal immigration
residency restrictions;
5. Any
child born to a woman eligible under the provisions of this chapter (except to
a presumptively eligible pregnant woman who has subsequently been found
ineligible for the month the child was born) shall remain eligible for a period
of not less than 60 days from his or her birth and up to one year, so long as
the mother remains eligible for NJ FamilyCare, or would remain eligible if
pregnant, whether or not application has been made, if the child lives with his
or her mother.
i. Notwithstanding (a)5 above,
any child resulting from the pregnancy shall be eligible for NJ FamilyCare, if
not otherwise eligible for Medicaid or the NJ FamilyCare Children's Program,
without regard to changes in the household unit's income for a period of not
less than 60 days and up to a period of one year, so long as the mother remains
eligible for NJ FamilyCare, or would remain eligible if pregnant, and the child
remains in the mother's custody;
6. Parents, or caretakers, of dependent
children under the age of 19 who meet the eligibility criteria contained in
(a)6i through iv below and in this chapter, and who either were enrolled for
benefits in the NJ FamilyCare Program on or after September 1, 2005, and
continuously have received those benefits or have a pending application for
such benefits that was received on or before February 28, 2010. The gross
family income standards for eligibility of such individuals follows:
i. Effective September 1, 2005, parents, or
caretakers, of dependent children under the age of 19 whose gross family income
does not exceed 100 percent of the Federal Poverty Level;
ii. Effective September 1, 2006, parents, or
caretakers, of dependent children under the age of 19 whose gross family income
does not exceed 115 percent of the Federal Poverty Level;
iii. Effective September 1, 2007, parents, or
caretakers, of dependent children under the age of 19 whose gross family income
does not exceed 133 percent of the Federal Poverty Level; and
iv. Effective September 1, 2008, and applying
to NJ FamilyCare existing enrollments under this paragraph and applications
received by February 28, 2010, parents or caretakers of dependent children
under the age of 19 whose gross family income does not exceed 200 percent of
the Federal Poverty Level; and
7. Any individual receiving NJ FamilyCare
under the provisions of this chapter who is receiving inpatient services
covered by NJ FamilyCare shall continue to be eligible for FamilyCare until the
end of the stay for which the inpatient services are furnished, notwithstanding
any other provision of this chapter.
(b) For all enrollment 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, except as
described in (b)1 below. Therefore, such applications for such persons will not
be processed for enrollment. This exclusion from enrollment and benefits
additionally applies to parents or caretakers who are applying to enroll after
being terminated from enrollment in the NJ FamilyCare Program, including, but
not limited to, individuals who have been terminated due to non-payment of
premiums or other amounts due.
1. This
exclusion from enrollment and benefits does not apply to parents or caretakers
who are enrolled in NJ FamilyCare and who subsequently become enrolled in one
of the State's programs for pregnant women, provided that they otherwise
continue to be eligible for NJ FamilyCare benefits at the time of application
and provided that they apply for re-enrollment in NJ FamilyCare at the close of
their coverage under the other program.
(c) Effective June 15, 2002, applicants who
are restricted alien children, as defined at
10:78-3.2, shall be uninsured and
financially eligible for the NJ FamilyCare Children's Program Plans A, B, C or
D, in accordance with the provisions of N.J.A.C. 10:79.
(d) On and after April 1, 2010, applicants or
beneficiaries who are adult restricted aliens, as defined at
10:78-3.2, shall be ineligible for
enrollment in, and benefits from, the NJ FamilyCare Program or any other
program under this chapter, except as allowed pursuant to
10:78-3.2(e)2.
This termination of enrollment and benefits under the program does not apply to
individuals who are pregnant women or children under the age of 19.
