Page 72

N.J.A.C. 10:69-3.15 This file includes all Regulations adopted and published through the New Jersey Register, Vol. 57 No. 12, June 16, 2025 NJ - New Jersey Administrative Code > TITLE 10. HUMAN SERVICES > CHAPTER 69. AFDC-RELATED MEDICAID > SUBCHAPTER 3. ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID § 10:69-3.15 Deprivation of parental support or care (AFDC-C) (a) The statutory definition of "dependent child" sets forth two eligibility factors: economic "need" and "deprivation of parental support or care." These two factors are not identical, and the law requires that both be demonstrated in each case. (b) "Need" refers to financial eligibility and is determined in accordance with the provisions contained in this chapter. (c) "Deprivation" is the result of death, physical or mental incapacity, or continued absence from the home of a natural or adoptive parent. 1. A child may be found to be deprived of parental support or care by reason of the documented death of either or both natural or adoptive parent(s). 2. A child may be found to be deprived of parental support or care by reason of the physical or mental incapacity of either or both natural or adoptive parent(s) whether such parent is in the home or is receiving treatment away from home. (d) The determination of incapacity for persons other than those delineated in N.J.A.C. 10:69-2.9 is made by the Disability Review Section, Division of Medical Assistance and Health Services, on the basis of medical evidence provided by the eligibility worker. This is done in the following way: 1. Forms DRS-1 (or DRS-1A) and DRS-2 must be completed and forwarded with all pertinent medical and hospital records to the Disability Review Section, Division of Medical Assistance and Health Services. This should be done as quickly as possible and shall be completed within 30 days. i. Give Form DRS-1 or DRS-1A to applicant to be filled in by his or her physician and returned to the welfare agency. If applicant prefers, the eligibility worker shall send the form with signed release to the doctor. The client should be warned that many physicians might not be as prompt in returning this form by mail as when filling it in the client's presence. When the form is returned, it shall be reviewed for completeness, including the physician's signature. ii. Complete Form DRS-2 (Medical Social Information Report). This requires full and careful discussion with applicant of the relevant information and possibly a home visit. (e) The existence of a physical or mental defect, illness, or impairment must be substantiated by current medical information (pertinent within the past three months): 1. This requires evidence of a defect, illness or impairment that is described by an examining physician in such a manner that another physician would reasonably accept the concept that incapacity exists without examining the client. 2. The unsupported opinion of the examining physician that an incapacity exists may, in itself, be accepted. However, material presented under the heading of Social Evaluation and Plan on Form DRS- 2 or in other portions of the case record should also be evaluated in demonstrating that incapacity exists.