N.J. Admin. Code § 10:72-7.4

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:72-7.4 - Policies governing the presumptive eligibility processing performed by the presumptive eligibility determination entity

(a) From preliminary information provided by a parent, guardian, or caretaker relative, the approved presumptive eligibility entity shall determine if the child meets the eligibility criteria of this subchapter as it applies to children. The approving presumptive eligibility entity shall obtain sufficient information from the parent, guardian, or caretaker relative to complete the certificate of presumptive eligibility. For purposes of the presumptive eligibility determination, the approved presumptive eligibility determination entity shall request from the parent, guardian, or caretaker relative only that information necessary to determine the child's presumptive eligibility or ineligibility. The approved presumptive eligibility determination entity shall make the determination of eligibility based solely on information obtained in the interview and shall not require any verification or documentation of the presumptive eligibility beneficiary's statements.

(b) For any child determined presumptively eligible, the approved presumptive eligibility determination entity shall:

1. Complete and sign the certificate of presumptive eligibility and forward the original of the certificate of presumptive eligibility to the Division of Medical Assistance and Health Services within two working days of the date the presumptive eligibility determination was made;

2. Forward a copy of the completed certificate and the referral, if appropriate, to the eligibility determination agency of the applicant's choice;

3. Inform the parent, guardian, or caretaker relative that they must contact the eligibility determination either by mailing an application to the Statewide eligibility determination agency or by arranging for a face-to-face interview with the county board of social services in order to complete the application process;

4. Give the parent, guardian, or caretaker relative of the presumptively eligible child a copy of both the certificate and the referral, if completed; and

5. Advise the parent, guardian, or caretaker relative of the presumptively eligible child, in writing, of the address and telephone number of the eligibility determination agency that the parent, guardian, caretaker relative or sponsoring adult chose.

(c) For any child for whom the approved presumptive eligibility determination entity is unable to determine presumptive eligibility, or who is ineligible under the criteria and standards of this subchapter or any other Division rules applicable to children, the approved presumptive eligibility determination entity shall refer the child to the appropriate eligibility determination agency for evaluation of potential eligibility for any other Medicaid or NJ FamilyCare programs. The address and telephone number of the appropriate eligibility determination agency shall be provided, in writing, to the parent, guardian or caretaker relative of the child.

N.J. Admin. Code § 10:72-7.4

Amended by R.2008 d.30, effective 1/22/2008.
See: 39 N.J.R. 3704(a), 40 N.J.R. 723(a).
In (c), substituted "FamilyCare" for "KidCare" and deleted the comma following "guardian".