N.J. Admin. Code § 8:61-3.3

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

Section 8:61-3.3 - ADDP income and residency eligibility criteria

(a) To be eligible to participate, or to renew one's participation, in the ADDP, an applicant shall be a permanent resident of New Jersey and have an annual household income that does not exceed 500 percent of the Federal poverty guidelines.

(b) The Department will calculate an applicant's financial eligibility for participation in the ADDP based on the applicant's MAGI-based income.

(c) ADDP eligibility is valid for 12 months from a participant's date of enrollment.

1. The Division shall transmit written notice to participants annually that provides an application for renewal of enrollment and specifying the deadline and procedure for submission of renewal applications.

2. An applicant's case manager may assist participants in submission of renewal applications, as necessary.

(d) Upon application for renewal of an applicant's enrollment in the ADDP, if the applicant's actual household income for the previous year exceeded 500 percent of the Federal poverty guidelines, but is not expected to exceed that amount in the upcoming year for which the applicant is seeking reenrollment, the Division will review on a case-by-case basis whether the applicant remains eligible for reenrollment in the ADDP, with the overriding consideration being the prevention of HIV transmission based on the likelihood that the applicant would continue to adhere to a medication regimen if not reenrolled, in view of the applicant's overall financial circumstances, and given the relative cost that the applicant would incur to obtain prescribed HIV medications if not reenrolled.

(e) The ADDP program shall take necessary action to recover from a third party, the full amount of payments it may have made to the third party, on behalf of a participant, during a period of the participant's ineligibility, when appropriate.

(f) Upon request of an applicant, the Division will assist an applicant to enroll in Medicare Part D Low Income Subsidy (LIS), pursuant to 20 CFR Part 418, Subpart D, and 42 CFR Part 423, upon the applicant's submission of all income and asset information that is necessary to apply.

1. The Division may provide payments from ADDP funds for LIS premiums and medication copayments for enrolled participants, subject to the availability of funding.

(g) The Division shall determine an applicant's New Jersey residency in accordance with the residency standards established for the PAAD program at N.J.A.C. 10:167-6.4.

N.J. Admin. Code § 8:61-3.3

Amended by 57 N.J.R. 29(a), effective 1/6/2025