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N.J.A.C. 10:72-6.2 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 6. PRESUMPTIVE ELIGIBILITY § 10:72-6.2 Responsibilities of a qualified provider (a) From preliminary information provided by a woman whose pregnancy has been medically verified, the qualified provider shall determine if the pregnant woman meets the eligibility criteria of this chapter as it applies to pregnant women. The qualified provider must obtain sufficient information from the pregnant women to complete the Certification of Presumptive Eligibility (FD-334) by having the pregnant women complete, sign and date a referral for Medicaid benefits as designated and provided by the Division of Medical Assistance and Health Services. For purposes of the presumptive eligibility determination, the qualified provider shall request from the pregnant woman only that information necessary to determine her presumptive eligibility or ineligibility. The qualified provider shall make the determination of eligibility based solely on information obtained in the interview and shall not require any verification or documentation of the pregnant woman's statements. 1. For any pregnant woman determined presumptively eligible, the qualified provider shall complete and sign the FD-334. The completed FD-334 together with the pregnant woman's New Jersey Care Pregnant Women and Infants Application Referral (FD-335) for Medicaid shall be mailed or otherwise forwarded to the county social service agency of the pregnant woman's county of residence within two working days of the presumptive eligibility determination. The qualified provider shall also forward a copy of the pregnant woman's Certification of Presumptive Eligibility (FD-334) to the Division of Medical Assistance and Health Services. The qualified provider shall inform the pregnant woman that her presumptive eligibility provides only limited services for a period of time not to exceed the length of the presumptive eligibility period, and that she must contact the county social service agency in order to set up an appointment to complete the application process for Medicaid benefits. The qualified provider shall give the presumptively eligible pregnant woman a copy of both the Certification of Presumptive Eligibility (FD-334) and her New Jersey Care Pregnant Women and Infants Application Referral (FD- 335) for Medicaid benefits. The qualified provider shall advise the presumptively eligible pregnant woman, in writing, of the address and telephone number of the appropriate county social service agency office. 2. For any woman for whom the qualified provider is unable to determine presumptive eligibility or who is ineligible under the criteria and standards of this chapter as it applies to pregnant women, the qualified provider shall refer the woman to the county social service agency for evaluation of potential eligibility for Medically Needy or other Medicaid entitlement. The address and telephone number of the appropriate county social service agency office shall be provided, in writing, to the pregnant woman. History HISTORY: Amended by R.1992 d.10, effective January 6, 1992. See: 23 N.J.R. 2827(a), 24 N.J.R. 100(a).