Page 18

N.J.A.C. 10:72-2.1 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 72. NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL > SUBCHAPTER 2. CASE PROCESSING § 10:72-2.1 Application (a) Application for Medicaid benefits for pregnant women and infants shall be accomplished by the completion and signing of Form FD-335 for pregnant women and infants as well as any addenda to that form as prescribed by the Division of Medical Assistance and Health Services. Application for Medicaid benefits for aged, blind, or disabled individuals shall be accomplished by the completion and signing of Form PA-1G as well as any addenda to that form as prescribed by the Division of Medical Assistance and Health Services. 1. The application for the program shall be executed by: i. The pregnant woman (regardless of age); ii. The parent, guardian, or caretaker relative of an infant or a blind or disabled child for whom Medicaid is sought; or iii. The aged, blind or disabled individual. 2. For cases in which, because of confinement, illness, incapacity, disability, or lack of competence of a person specified in (a)1 above, the application may be executed on behalf of such person by: i. A relative by blood or marriage; ii. A staff member of a public or private welfare or social service agency of which the person seeking assistance is a client and who has been designated by the agency to so act; iii. An attorney or physician of the person seeking Medicaid benefits; or iv. A staff member of an institution or facility in which the individual is receiving care and who has been designated by the institution or facility to so act. 3. A legal guardian shall be recognized as an authorized agent to execute an application on behalf of any individual. (b) The county social service agency, under policies and procedures established by the Division of Medical Assistance and Health Services, has the direct responsibility in the application process to: 1. Inform applicants of the purpose of and the eligibility requirements for the Medicaid program, including their rights to a fair hearing; 2. Receive applications and review them for completeness, consistency, and reasonableness; 3. Assist program applicants in exploring their eligibility for program benefits; 4. Make known to program applicants the appropriate resources and services both within the agency and in the community; and 5. Assure the prompt and accurate submission of eligibility data to the Medicaid Eligibility File for eligible persons and prompt notification to ineligible persons of the reason for their ineligibility.