N.J. Admin. Code § 10:90-5.9

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

Section 10:90-5.9 - Medicaid extension (employment-related)

(a) Extended Medicaid benefits are available to families who lose eligibility for Medicaid due to employment-related criteria based on the income standards and methodologies in effect for the Aid to Families with Dependent Children (AFDC) program as of July 16, 1996. Thus, extended Medicaid benefits will begin with the loss of WFNJ cash assistance only when that loss was coincident with the loss of Medicaid eligibility under the July 16, 1996 AFDC income standards and methodologies in accordance with N.J.A.C. 10:69.

(b) When a family with dependent children loses eligibility for Medicaid based on the income standards and methodologies in effect for the AFDC program as of July 16, 1996, for the reasons given below, Medicaid eligibility continues for a period of 24 months beginning with the month in which the family was no longer eligible under those standards and methodologies. The 24-month extension period shall begin, even though the family may continue to receive WFNJ cash assistance.

1. Earnings or increased earnings from employment, including earnings from new employment;

2. Earnings or income from employment combined with child support collections, when earnings are a significant contributing factor to case closing;

3. Loss of the $ 30.00 and one-third income disregards because of the time-limited application of those disregards;

4. Increased hours of employment; and

5. Receipt of New Jersey State unemployment or temporary disability insurance benefits.

(c) A family with dependent children, whose case closes for reasons other than employment, that gains employment within the 24 months after case closing, may be eligible to receive extended Medicaid benefits for the balance of the 24 month Medicaid extension period which would have begun at case closing.

(d) Persons who secure employment through the Early Employment Initiative (EEI) program (see N.J.A.C. 10:90-17) may be eligible for 24 months of extended Medicaid benefits.

(e) New members added to a family in receipt of extended Medicaid are not included in the extended coverage, with the exception of a child born to or legally adopted by the family during the extension period.

(f) The following individuals shall not be included, or continue to be included, in the eligible WFNJ/TANF assistance unit for Medicaid extension:

1. Any child who reaches the age of 18, or if a full-time student in secondary or vocational school, until the month of graduation or attainment of the age of 19, whichever is first. Any child who is about to become ineligible due to age shall be evaluated for eligibility under other components of the Medicaid program; and

2. All other family members who are receiving Medicaid extension solely based on the presence in the home of a child who has attained the age maximums stated in (d)1 above.

(g) When the last remaining child eligible for Medicaid extension is no longer eligible for an extension, eligibility for the other members ceases.

(h) Medicaid shall be the payer of last resort in those instances in which a recipient or his or her dependent child(ren) have third party (employer-provided or from a noncustodial parent) health care coverage.

N.J. Admin. Code § 10:90-5.9

Amended by R.2003 d.226, effective 6/16/2003.
See: 34 New Jersey Register 2713(a), 35 New Jersey Register 2670(a).
In (a), added N.J.A.C. reference; added a new (c) and (d); and recodified former (c) through (f) as (e) through (h).