N.J. Admin. Code § 10:79-1.1

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

Section 10:79-1.1 - Purpose and scope

(a) NJ FamilyCare-Children's Program is a program administered by the Division of Medical Assistance and Health Services, Department of Human Services to provide plan-defined health care benefits to certain children.

(b) The purpose of the rules contained within this chapter is to:

1. Set forth eligibility criteria for the NJ FamilyCare-Children's Program;

2. Specify the rights and responsibilities of program applicants and eligible persons; and

3. Describe the administration of the program.

(c) Because the eligibility criteria established by the rules contained within this chapter are more liberal than those applicable under AFDC-related Medicaid and SSI-related Medicaid, children losing AFDC-related eligibility because of financial reasons should be evaluated under the provisions of this chapter for the possibility of NJ FamilyCare-Children's Program eligibility.

(d) Children eligible under this chapter are eligible for NJ FamilyCare-Children's Program-Plan A, Plan B, Plan C or Plan D services which are set forth in N.J.A.C. 10:49-5. NJ FamilyCare-Children's Program-Plan A is a means-tested Federal entitlement program.

(e) Plans B, C and D are not Federal entitlement programs. Enrollment and expenditures shall be monitored closely. Enrollment shall be stopped when total expenditures are projected to equal the available funding level. If that point is reached, any additional applicants shall be placed on a waiting list, with preference determined based on date of enrollment and income.

(f) Persons financially ineligible for Medicaid under the provisions of N.J.A.C. 10:69, 10:71 and 10:72 and who are income ineligible for NJ FamilyCare-Children's Program under the provisions of this chapter shall be evaluated for eligibility as Medically Needy under the provisions of N.J.A.C. 10:70 or shall be referred to the NJ FamilyCare Advantage Program.

N.J. Admin. Code § 10:79-1.1

Amended by R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 N.J.R. 1060(a).
Inserted new (d) and (e); and recodified former (d) and (e) as (f) and (g).
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 N.J.R. 1060(a), 30 N.J.R. 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.1999 d.211, effective 7/6/1999 (operative August 1, 1999).
See: 31 N.J.R. 998(a), 31 N.J.R. 1806(a), 31 N.J.R. 2879(b).
In (d) and (e), inserted references to Plan D.
Amended by R.2004 d.42, effective 1/20/2004.
See: 35 N.J.R. 3802(a), 36 N.J.R. 572(b).
In (d), added the last sentence; in (f), amended the N.J.A.C. references; deleted (g); substituted references to the NJ FamilyCare-Children's Program for references to NJ KidCare throughout.
Amended by R.2009 d.232, effective 7/20/2009.
See: 41 N.J.R. 945(a), 41 N.J.R. 2793(a).
In (f), inserted "or shall be referred to the NJ FamilyCare Advantage Program".