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Page 3 of 3 § 10:72-3.4 Eligible persons Chapter Notes Case Notes Division of Medical Assistance and Health Services correctly denied a 90-year-old Russian immigrant's request for Medicaid benefits under the New Jersey Care Program (NJCare), N.J.A.C. 10:72-1.1 through 10:72-9.8, based on the five-year bar on receipt of NJCare benefits under N.J.A.C. 10:72-3.2, due to his failure to remain continuously present in the United States since his last visit in the spring of 1996, despite his status as a lawful permanent resident (LPR), as the five year ban was applicable to LPRs entering the United States on or after August 22, 1996. A.B. v. Division of Med. Assistance & Health Servs., 407 N.J. Super. 330, 971 A.2d 403, 2009 N.J. Super. LEXIS 126 (2009). New Jersey Medical Assistance and Health Benefits Act, N.J.S.A. 30:4D-1 to 30:4D-19.5, defines "eligible alien," pursuant to N.J.S.A. 30:42-3q, and that definition clearly creates two classes of lawful permanent residents, namely those who entered the United States before August 22, 1996, and those who entered on or after that date. The regulations governing New Jersey Care Benefits cannot be construed to avoid that statutory definition and create a third class, namely those who visited the United States before August 22, 1996, who then became lawful permanent residents on or after that date, thus avoiding the five-year bar that the Legislature imposed on receipt of benefits under the Act via N.J.A.C. 10:72-3.2. A.B. v. Division of Med. Assistance & Health Servs., 407 N.J. Super. 330, 971 A.2d 403, 2009 N.J. Super. LEXIS 126 (2009). Household income of a 66-year old single male exceeded the ceiling for unearned income and disqualified him for Medicaid benefits because the amount of his monthly Social Security check that was deducted to pay the premium for Medicare Part B coverage was required to be included in the determination of countable income. S.B. v. Somerset Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 08799-16, 2016 N.J. AGEN LEXIS 758, Initial Decision (September 12, 2016). Pregnant woman who was awarded Medicaid coverage in connection with her pregnancy, which was expected to last until she delivered her baby, was not properly required to repay amounts paid to two health care providers in connection with what was expected to be prenatal care which would be provided to her. The woman's pregnancy in fact had terminated soon after the Medicaid award was made, she was unaware of the fact that it had been awarded, and she had made no use of the benefits. That being undisputed, an administrative law judge concluded that it would be inequitable to hold her financially responsible for funds that she did not know had been paid on her behalf and from which she accrued no benefit. E.S. v. Hunterdon Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 11012-14, 2014 N.J. AGEN LEXIS 834, Initial Decision (December 1, 2014). Petitioner's application for Medicaid was properly denied because the county board of social services contacted her on four different occasions at the address that she had provided to request verification of various items in the application, and the petitioner did not provide the requested materials. Since the application, by law, had to be processed within 90 days of filing, petitioner's cognate claim that the board had failed to act in a timely manner was unsubstantiated. N.R. v. DMAHS and Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 07734-14, 2013 N.J. AGEN LEXIS 615, Final Agency Decision (September 19, 2013). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law End of Document