N.J. Admin. Code § 10:72-3.4 - Eligible persons

Current through Register Vol. 54, No. 7, April 4, 2022

(a) The following persons who meet all eligibility criteria of this chapter are eligible for Medicaid benefits:
1. Pregnant women: Women of any age during the term of a medically verified pregnancy.
i. A woman who is determined eligible under the criteria of this chapter will, for purposes of eligibility, be considered to be a pregnant woman until the end of the 60-day period beginning with the last day of her pregnancy. Her eligibility as a pregnant woman shall end on the last day of the month in which the 60-day period ends.
2. Children under the age of one.
3. A child born to a woman eligible under the provisions of this chapter (except to a presumptively eligible pregnant woman who has subsequently been found ineligible for the month the child was born) shall remain eligible for a period of not less than 60 days from his or her birth and up to one year, so long as the mother remains eligible for Medicaid, or would remain eligible if pregnant, whether or not application has been made, if the child lives with his or her mother. This also applies to an infant born to a mother whose labor and delivery were covered by Medicaid as emergency services even though the mother cannot receive Medicaid services except for emergency services.
4. Any child receiving Medicaid under the provisions of this chapter who but for the age limits in (a)2 above would be eligible for Medicaid under the provisions of this chapter and who is receiving inpatient services covered by Medicaid at the time he or she reaches the age limit, will continue to be eligible for Medicaid until the end of the stay for which the inpatient services are furnished.
5. Aged individuals: Persons who are age 65 years or older.
6. Disabled individuals: Persons who have been medically determined to meet the criteria of disability as set forth at 10:71-3.10 through 3.13.
7. Blind individuals: Persons who have been medically determined to meet the criteria of blindness as set forth at 10:71-3.10 through 3.13.


N.J. Admin. Code § 10:72-3.4
Emergency Amendment, R.1988 d.96, effective 2/2/1988 (expired April 2, 1988).
See: 20 N.J.R. 548(a).
Added (a)6.-8.
Adopted Concurrent Proposal, R.1988 d.212, effective 5/16/1988.
See: 20 N.J.R. 548(a), 20 N.J.R. 1103(a).
Amended by R.1989 d.397, effective 8/7/1989.
See: 21 N.J.R. 965(a), 21 N.J.R. 2383(a).
Provisions on eligibility of newborn added at (b).
Emergency Amendment, R.1991 d.223, effective 3/28/1991 (operative April 1, 1991; expires May 27, 1991).
See: 23 N.J.R. 1200(a).
Deleted obsolete language and adopted Federally required coverage pursuant to Omnibus Budget Reconciliation Act of 1989.
Adopted Concurrent Proposal, R.1991 d.302, effective 5/24/1991.
See: 23 N.J.R. 1200(a), 23 N.J.R. 1945(a).
Provisions of emergency amendment R.1991 d.223 readopted without change.
Amended by R.1991 d.483, effective 10/7/1991.
See: 23 N.J.R. 1889(a), 23 N.J.R. 3028(a).
In (a)3: revised text to clarify eligibility for newborns of Medicaid eligible women in Medicaid recipients. Added text regarding presumptively eligible pregnant women who have been found ineligible for the month the child was born.
Amended by R.1992 d.484, effective 12/7/1992.
See: 24 N.J.R. 1860(a), 24 N.J.R. 4378(a).
Eligibility expanded to include children of specified ages born after September 30, 1983.
Amended by R.1997 d.379, effective 9/15/1997.
See: 29 N.J.R. 2541(a), 29 N.J.R. 4136(a).
In (a)1i, added the last sentence.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
In (a), rewrote 2.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.1999 d.253, effective 8/2/1999.
See: 31 N.J.R. 97(a), 31 N.J.R. 2203(b).
In (a)3, added a second sentence.
Amended by R.2008 d.30, effective 1/22/2008.
See: 39 N.J.R. 3704(a), 40 N.J.R. 723(a).
In (a)1, substituted "Women" for "Needy women".

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