New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 79 - NJ FAMILYCARE-CHILDREN'S PROGRAM
Subchapter 2 - CASE PROCESSING
Section 10:79-2.4 - Application processing for the unborn NJ FamilyCare-Children's Program-Plan C and Plan D
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The eligibility determination agency may accept and process an application for an unborn child in the last trimester of the pregnant woman's term, but whose income is greater than 200 percent, but not greater than 350 percent of the Federal poverty level.
(b) Eligibility should be processed utilizing information that is projected to be effective at the time of the birth of the child. The eligibility determination agency and/or the CWA shall conduct a status review at the time of the birth of the child. The redetermination date for the family shall be moved to the date that the newborn was added to the case record.
(c) At the time of the application, the pregnant woman should select the unborn child's MCO coverage, and provide the appropriate premium.
(d) The pregnant woman shall notify both the eligibility determination agency and the selected MCO of the birth of the child within 10 calendar days of the birth. Failure to report the birth, select the MCO, if not already selected, and pay the premium, if not yet paid, within 10 calendar days of the birth shall negate the original application, and the applicant for the newborn shall have to refile a new application with verification of eligibility reprocessed before eligibility can occur for the newborn. In the instance where a new application must be processed, the eligibility rules in this subchapter through N.J.A.C. 10:79-4 are effective.
