N.J. Admin. Code § 10:155-1.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:155-1.3 - General requirements

(a) Pursuant to the Act, the Fund will provide assistance to families having a child with a catastrophic illness. To be eligible for the Fund's assistance, a child's verified medical expenses, incurred in any prior consecutive 12-month period in the seven years (84 months) prior to the date of application for assistance, must exceed the amount equal to 10 percent of the first $ 100,000 of verified annual income of a family plus 15 percent of the excess income over $ 100,000. The date of application is the date the application is postmarked and mailed, faxed, or electronically delivered to the State Office. See N.J.A.C. 10:155 Appendix I, for example calculations of eligibility for Fund assistance for families with different income levels.

1. Ten percent shall be the screen used for families whose income is $ 100,000 or less.

2. Ten percent of the first $ 100,000 of annual income of a family plus 15 percent of the excess income over $ 100,000 shall be the screen used for families whose income is more than $ 100,000.

(b) Though the child shall be referred to as being eligible at the point in the application process when the child has passed the initial screen, actual Fund disbursements on behalf of a child shall be limited by the monies available in the Fund and shall be guided by the policies and procedures outlined in the subchapter.

(c) To be eligible for assistance, a child must be a resident of the State of New Jersey. "Resident" means a person legally domiciled in New Jersey for a period of three months immediately preceding the date of application for assistance to the Fund.

1. A child's state of residence is that state in which the child resides, either with a parent or legal guardian, or alone if the child has reached the age of 18 or is emancipated from the care and custody of a parent or guardian.

2. Establishing proof of legal domicile within New Jersey is a responsibility of the parent or legal guardian of a child, or the child, if the child has reached the age of 18, or is emancipated from the care and custody of a parent or guardian. For the definition of domicile, see N.J.A.C. 9A:5-1.1.

3. Absence from New Jersey for a period of 12 months or more is prima facie evidence of abandonment of domicile.

4. Seasonal or temporary residence within the State, of whatever duration, does not constitute domicile.

N.J. Admin. Code § 10:155-1.3

Amended by R.1993 d.438, effective 9/7/1993.
See: 25 N.J.R. 2169(a), 25 N.J.R. 4128(a).
Amended by R.1994 d.572, effective 11/7/1994.
See: 26 N.J.R. 3573(a), 26 N.J.R. 4380(a).
Amended by R.1997 d.157, effective 4/7/1997.
See: 28 N.J.R. 5028(b), 29 N.J.R. 1317(a).
In (a), inserted references to verification of medical expenses.
Amended by R.1999 d.354, effective 10/18/1999.
See: 31 N.J.R. 2164(a), 31 N.J.R. 3090(a).
In (a), substituted references to 10 percent for references to 15 percent and substituted references to 15 percent for references to 20 percent throughout; and in (b), deleted "enrolled or" following "being".
Amended by R.2004 d.352, effective 9/20/2004.
See: 36 N.J.R. 2974(a), 36 N.J.R. 4314(a).
In (a), substituted "as specified in this chapter" for "(not covered by private insurance or other public programs)" in the introductory paragraph, and substituted "of" for "or" in 2.
Amended by R.2010 d.032, effective 5/17/2010.
See: 41 N.J.R. 3360(a), 42 N.J.R. 937(a).
In the introductory paragraph of (a), inserted a comma following "expenses" and "period", and substituted "equal to" for "represented by"; in the introductory paragraph of (c), deleted "initial" preceding "date"; and rewrote (c)4.

Amended by 54 N.J.R. 780(b), effective 5/2/2022

Amended by 54 N.J.R. 1552(b), effective 8/1/2022