N.J. Admin. Code § 10:79-8.4 - Presumptive eligibility processing performed by the presumptive eligibility determination entity

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

(a) From preliminary information provided by a child (if appropriate), parent, guardian, caretaker adult, or authorized agent, the approved presumptive eligibility entity shall determine if the child meets the eligibility criteria of this chapter. The approved presumptive eligibility entity shall obtain sufficient information from the child (if appropriate), parent, guardian, caretaker adult, or authorized agent to complete the one-page Presumptive Eligibility (PE) application. For purposes of the presumptive eligibility determination, the qualified presumptive eligibility determination entity shall request from the child (if appropriate), parent, guardian, caretaker adult, or authorized agent only that information necessary to determine the child's presumptive eligibility or ineligibility. The qualified presumptive eligibility determination entity shall make the determination of eligibility based solely on information obtained in the interview and shall not require any verification or documentation of the presumptively eligible beneficiary's statements. A one-page PE application shall be used to apply for presumptive eligibility for NJ FamilyCare services.
(b) For any child determined presumptively eligible, the approved presumptive eligibility determination entity shall:
1. Complete and sign the one-page Presumptive Eligibility (PE) application and forward the original to the appropriate eligibility determination agency within two working days of the date the presumptive eligibility determination was made.
i. An application that appears to meet the eligibility criteria for NJ FamilyCare-Children's Program-Plan A shall be sent to the county welfare agency for the child's county of residence; and
ii. An application that appears to meet the eligibility criteria for NJ FamilyCare-Children's Program-Plan B, C, or D shall be sent to the Statewide eligibility determination agency;
2. Forward a copy of the completed application to the Division of Medical Assistance and Health Services.
i. If the PE application is completed online at https://pe.dhs.state.nj.us, the processes described in (b)1 and 2 above are performed automatically.
3. Inform the child (if appropriate), parent, guardian, caretaker or authorized agent that the eligibility determination agency will contact the applicant to obtain additional documentation needed to complete the application process for full Medicaid or NJ FamilyCare-Children's Program benefits. It is the applicant's responsibility to provide all information requested to complete the application process;
4. Give the child (if appropriate) or the parent, guardian, caretaker, or authorized agent of the presumptively eligible child a copy of the completed one-page PE application; and
5. Advise the child (if appropriate), parent, guardian, caretaker, or authorized agent of the presumptively eligible child, in writing, of the address and telephone number of the eligibility determination agency to which the one-page PE application is being forwarded.
(c) For any child for whom the approved presumptive eligibility determination entity is unable to determine presumptive eligibility, or who is ineligible under the criteria and standards of this chapter, the qualified presumptive eligibility determination entity shall refer the child to the county welfare agency for evaluation of potential eligibility for any other Medicaid, Medically Needy or NJ FamilyCare-Children's Program entitlement programs. The address and telephone number of the appropriate office shall be provided, in writing, to the child (if appropriate), parent, guardian, caretaker, or authorized agent of the child.

Notes

N.J. Admin. Code § 10:79-8.4
Amended by 49 N.J.R. 203(a), effective 1/17/2017

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