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Effective Date: April 1, 2009

Approval Date: ____________ 16

Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state's Medicaid plan, and continue on to Section 5.

4.1. The following standards may be used to determine eligibility of targeted low-income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1

Geographic area served by the Plan: Statewide 4.1.2

Age: Under 19 years of age 4.1.3

Income:

The application process now allows self-declaration of income in eight school districts of the State, of which at least two each are in the northern, central and southern areas of the State, respectively, and at least four of which are in the so- called “Abbott” (i.e., lower income) school districts.

For children in families with income at or below 133% of the federal poverty level, coverage is available under the Medicaid program (NJ FamilyCare Plan A). Household income is defined as the gross income, earned and unearned, that is available to the eligible unit. The eligible unit is comprised of natural or adoptive parent(s) and all blood-related or adoptive brothers or sisters living in the household.

In determining family income, the following deductions and disregards apply:

• For self-employed, the cost of producing income;

• From gross earnings the first $90.00 per month of such earnings for each employed individual in the eligible family (including earnings of a child under the age of 21 who is not a full-time student) to cover work-related expenses including, but not limited to, transportation and mandatory payroll deductions;

• From the remaining earned income, an amount equal to the actual expenditures for child care or for care of an incapacitated individual living in the same home as the eligible child when specific circumstances are met. Maximum amounts for this type of disregard are:

• $175.00 per month per child age two or older, or incapacitated adult, for full-time employment;

• $200.00 per month per child under age two, for full-time