Page 39

Page 2 of 3 § 10:70-3.4 Eligibility group criteria i. Disability for children under the age of 18 is any medically determinable physical or mental impairment which compares in severity to an impairment that would make an adult disabled. ii. Persons who are receiving Social Security disability benefits are presumed to be disabled for purposes of this program. iii. Except for persons described in (c)3ii above, the determination of disability is the responsibility of the Division of Medical Assistance and Health Services, Disability Review Section. (d) Under certain circumstances, an individual may be considered for eligibility under both the SSI-related and AFDC-related categories (for example, a blind child under the age of 21). Such an individual may select the category under which he or she wishes to be considered for program eligibility upon being advised by the county board of social services of the option and the consequences thereof. History HISTORY: Amended by R.1989 d.397, effective August 7, 1989. See: 21 N.J.R. 965(a), 21 N.J.R. 2383(a). Provisions on eligibility of newborn and specification of time limit of eligibility of mother after delivery added at (b). Amended by R.1991 d.331, effective July 1, 1991. See: 23 N.J.R. 964(a), 23 N.J.R. 2042(a). Shift in administrative functions from Division of Public Welfare, Bureau of Medical Affairs, Medical Review Team to Division of Medical Assistance and Health Services, Disability Review Section. Amended by R.2006 d.364, effective October 16, 2006. See: 38 N.J.R. 2368(a), 38 N.J.R. 4480(c). In the introductory paragraph of (b), deleted "AFDC-related:" from the beginning; in (b)1, inserted "pregnant"; in (b)2ii, updated N.J.A.C. references; in the introductory paragraph of (c), deleted "SSI-related:" from the beginning; in (c)1, substituted "who are" for "aged"; and in (d), substituted "board of social services" for "welfare agency". Annotations Notes Chapter Notes Case Notes Appeal by applicant for eligibility under Medicaid Nursing Home Program as of August 31, 2014 was properly dismissed because while the applicant showed clinical eligibility and the applicant's income satisfied either the budget unit or the medical spend down requirements in governing regulations, the applicant did not satisfy the resource limits until April 2015 and thus did not have eligibility until then. M.P. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 02517-16, 2017 N.J. AGEN LEXIS 163, Final Administrative Determination (March 16, 2017). Initial Decision (2006 N.J. AGEN LEXIS 980) adopted, which found that receipt of disability-related Social Security benefits (RSDI or SSDI) did not qualify a Medically Needy program applicant for Medically Needy spend-down