N.J. Admin. Code § 10:78-4.1

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:78-4.1 - Calculation of income eligibility limits

(a) For parents, and caretakers, of dependent children under the age of 19 who applied as such for NJ FamilyCare benefits prior to June 15, 2002, and continuously have received those benefits, income limits shall be based on 200 percent of the poverty income guidelines as defined by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. § 9902(2). The monthly income standard shall be 1/12 of the annual poverty income guideline rounded up to the next whole dollar amount for household unit sizes. The annual revision to the Federal poverty income guideline shall be effective, for purposes of this section, with the first day of the calendar year for which the poverty income guideline is promulgated.

(b) Income limits for single adults and couples without dependent children covered under the provisions of this chapter shall be based on 100 percent of the poverty income guideline as defined by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. § 9902(2). The monthly income standard shall be 1/12 of 100 percent of the annual poverty income guideline rounded up to the next whole dollar amount for each household size of one and two. The annual revision to the Federal poverty income guideline shall be effective for the purposes of this section with the first day of the year for which the poverty guideline is promulgated.

(c) Income limits for NJ FamilyCare for pregnant women covered under the provisions of this chapter shall be based on 200 percent of the poverty income guidelines as defined by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. § 9902(2). The monthly income standard shall be 1/12 of the annual poverty income guideline rounded up to the next whole dollar amount for household unit sizes. The annual revision to the Federal poverty income guideline shall be effective for purposes of this section with the first day of the year for which the poverty income guideline is promulgated.

(d) Income limits for NJ FamilyCare for children under the age of 21 who would qualify for Medicaid Special under the provisions of N.J.A.C. 10:69, but for Federal immigration residency restrictions, shall be as specified in N.J.A.C. 10:69.

(e) Income limits for NJ FamilyCare for children under the age of 19 who would qualify for NJ FamilyCare but for Federal immigration residency restrictions shall be covered under the provisions of this chapter up to 350 percent of the poverty income guidelines as defined by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. § 9902(2). The monthly income standard shall be 1/12 of the annual poverty income guideline rounded up to the next whole dollar amount for household unit sizes. The annual revisions to the Federal poverty income guidelines shall be effective for purposes of this section with the first day of the year for which the poverty income guideline is promulgated.

(f) For applicants who are parents, or caretakers, of dependent children under the age of 19 who meet the eligibility criteria contained in 10:78-3.4(a)6 and this chapter, income limits for NJ FamilyCare shall be based on the percentage of the poverty income guidelines, as defined by the U.S. Department of Health and Human Services in accordance with 42 U.S.C. § 9902(2), listed in (f)1 to 3 below. The monthly income standard shall be 1/12th of the annual poverty income guideline rounded up to the next whole dollar amount for household unit sizes. The annual revision to the Federal poverty income guidelines shall be effective, for purposes of this Chapter, with the first day of the calendar year for which the poverty income guidelines are issued by the U.S. Department of Health and Human Services.

1. Effective September 1, 2005, the income limit for NJ FamilyCare for new applicants who are parents or caretakers of dependent children under the age of 19 shall be based on 100 percent of the Federal Poverty Level.

2. Effective September 1, 2006, the income limit for NJ FamilyCare for new applicants who are parents or caretakers of dependent children under the age of 19 shall be based on 115 percent of the Federal Poverty Level.

3. Effective September 1, 2007, the income limit for NJ FamilyCare for new applicants who are parents or caretakers of dependent children under the age of 19 shall be based on 133 percent of the Federal Poverty Level.

(g) In order to be eligible for NJ FamilyCare benefits under the provisions of this chapter, monthly household income (as determined by this chapter) shall be equal to or less than the income limit established in (a), (b), (c), (d), (e) or (f) above as applicable.

1. If a pregnant woman is determined to be income eligible during any month prior to the end of her pregnancy, she, if otherwise eligible, shall continue to be eligible without regard to changes in the household unit's income for the term of her pregnancy, including the 60-day period beginning with the last day of the pregnancy whether or not the pregnancy results in a live birth. If the income change results from the addition of a new household member, the new income is not considered through the 60-day period beginning with the last day of the pregnancy.

i. Any child resulting from the pregnancy shall be eligible for NJ FamilyCare, if not otherwise eligible for Medicaid or NJ FamilyCare, 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.

2. With the exception of (g)1 above, income eligibility exists for each month in which the household unit"s income is equal to or less than the income limits.

(h) The annual revision to the Federal poverty income guidelines reflected in this chapter shall be effective, on the first day of the calendar year for which the poverty income guidelines are issued by the U.S. Department Health and Human Services. Revisions to the specific dollar amounts will be published annually in the New Jersey Register as an administrative notice.

N.J. Admin. Code § 10:78-4.1

Amended by R.2006 d.347, effective 10/2/2006.
See: 38 N.J.R. 2602(a), 38 N.J.R. 3095(a), 38 N.J.R. 4222(a).
Section was "Income eligibility limits". Rewrote the section.