N.J. Admin. Code § 10:72-2.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:72-2.3 - Verification requirements

(a) The county welfare agency is required to verify all factors related to eligibility for the Medicaid program. Factors subject to verification include:

1. Pregnancy: For women seeking benefits under the provisions of this chapter, pregnancy must be medically verified. The medical verification must include the estimated dates of conception and delivery.

2. Disability and blindness: For individuals seeking Medicaid benefits because of disability or blindness, the condition must be established in accordance with the definitions, verification requirements, and processes set forth at 10:71-3.10 through 3.13.

3. Birth date: The birth date of any person for whom benefits are sought must be verified.

4. Alien status: The status of any alien seeking benefits must be verified to establish entitlement for Medicaid benefits.

5. Citizenship: When an applicant's or beneficiary's statements of U.S. citizenship are questionable, citizenship must be verified.

6. Household composition: The county welfare agency must verify the household composition in order to ascertain which persons will be included in the determination of eligibility for Medicaid benefits.

7. Social Security number: The Social Security number of any person seeking Medicaid benefits must be verified.

8. The county welfare agency must verify all sources of income of any person whose income must be counted in the determination of program eligibility. While resources are not a factor of eligibility for benefits for pregnant women and children under this chapter, resources must be identified and verified to determine if income is derived from the resources. For the aged, blind, and disabled, resources must be verified.

(b) The county welfare agency shall use documentary evidence as the primary source of verification. Documentary evidence is written confirmation of the family's circumstances. It is the responsibility of the applicant to obtain or to assist the county welfare agency in obtaining any required documentation.

(c) In circumstances in which the documentary evidence is questionable or is not available, the county welfare agency may use collateral contact to confirm the family's circumstances. A collateral contact is a verbal confirmation of a family's circumstances by a person outside the family. In order to be acceptable as verification, a collateral contact must 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 Medicaid program may not be established.

N.J. Admin. Code § 10:72-2.3

Emergency Adoption, R.1988 d.96, effective 3/20/1988.
See: 20 N.J.R. 548(a).
Added (a)2; renumbered all (a)2.-7. as 3.-8. and added text to (a)8. "pregnant women and children", "for the aged, blind and disabled, resources must be verified".
Readoption of Concurrent Proposal, R.1988 d.212, effective 5/16/1988.
See: 20 N.J.R. 548(a), 20 N.J.R. 1103(a).
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.