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N.J.A.C. 10:71-2.16 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 71. MEDICAID ONLY > SUBCHAPTER 2. THE APPLICATION PROCESS § 10:71-2.16 Retroactive eligibility for Medicaid (a) All applicants for Medicaid Only shall be queried as to whether or not they have outstanding unpaid medical bills incurred within the three month period prior to the month of application for Medicaid Only. Those indicating the existence of such bills are to be supplied with an "Application for payment of unpaid medical bills," form FD-74, for completion. The intake worker will be responsible for assisting the applicant, where necessary, in the interpretation and completion of the application form (regardless of whether the individual is eventually determined to be eligible for Medicaid). The intake worker will not be responsible for making a financial determination of eligibility for the three-month period in question. (b) The applicant shall attach all outstanding unpaid medical bills to the FD-74 form and forward it to the: Division of Medical Assistance and Health Services Retroactive Eligibility Unit PO Box 712 Mail Code 10 Trenton, NJ 08625-0712 (c) For individuals who are incapable of acting on their own behalf, an authorized agent can make application for retroactive Medicaid eligibility when there are outstanding medical bills. Such persons, at the time of application, should be provided with a form FD-74 for completion and submission to the retroactive eligibility unit with the unpaid medical bills attached. (d) In the case of an individual who is deceased, an authorized agent, as defined above, may make application for retroactive Medicaid eligibility by obtaining an application form FD-74 from either the county social service board or a Medical Assistance Customer Center. History HISTORY: Amended by R.1995 d.651, effective December 18, 1995. See: 27 N.J.R. 3543(a), 27 N.J.R. 5046(a). Amended by R.2000 d.415, effective October 16, 2000. See: 32 N.J.R. 2565(a), 32 N.J.R. 3844(a). In (a), substituted "Medicaid" for "public assistance" in the third sentence. Amended by R.2006 d.133, effective November 6, 2006. See: 37 N.J.R. 3774(a), 37 N.J.R. 4505(a), 38 N.J.R. 4712(a).