N.J. Admin. Code § 10:78-4.4

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

Section 10:78-4.4 - Income eligibility for single adults and couples without dependent children who applied as such for NJ FamilyCare benefits prior to September 1, 2001, and who have received those benefits continuously

(a) Before applying the NJ FamilyCare eligibility test, the eligibility determination agency staff shall evaluate, or make referrals, as appropriate, to determine eligibility for other medical coverage, including, without limitation, programs for the aged, blind and disabled, and Medicaid Special.

(b) When a single adult or couple without dependent children is determined not to be eligible for WFNJ/GA, the eligibility determination agency shall continue to evaluate possible eligibility for NJ FamilyCare or refer the application to the appropriate agency. Eligibility shall exist when the single adult or couple without dependent children meets the following financial criteria:

1. The gross income of an eligible single adult or couple without dependent children shall be no greater than 100 percent of the poverty level for the applicable family unit size, one or two, at the time the individual applies or reapplies for coverage, or when the case is reopened.

i. If one member of a couple is currently enrolled in a Medicaid program other than the Medically Needy program, that person's gross income shall not be counted in determining the eligibility of the other member of the couple for NJ FamilyCare.

(c) Those single adults and couples without dependent children who are determined eligible for NJ FamilyCare shall receive the NJ FamilyCare Plan "H" service package. The particular scope of services under Plan H is described at N.J.A.C. 10:49-5.8.

(d) Except as specified under the presumptive eligibility rules (N.J.A.C. 10:78-5) of this chapter:

1. The effective initial eligibility date shall be the first day of the month of the application date, if the individual was eligible on the application date.

i. If the applicant was not eligible on the application date, but was found to be eligible on any date other than the application date, the effective initial eligibility date shall be the first day of the month in which eligibility began.

N.J. Admin. Code § 10:78-4.4

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 for single adults and couples without dependent children". Deleted (b)1ii; and rewrote (c).