N.J. Admin. Code § 10:69-12.6
Current through Register Vol. 56, No. 23, December 2, 2024
Section 10:69-12.6 - Presumptive eligibility processing performed by the county welfare agency (CWA)(a) Upon receipt of the presumptive eligibility application from the qualified presumptive eligibility determination entity, the CWA shall check the Medicaid, Medically Needy, and NJ FamilyCare -- Children's Program Eligibility database for existing eligibility. If the child is receiving Medicaid or NJ FamilyCare -- Children's Program benefits, no further action shall be required by the CWA.(b) If the child is not currently receiving Medicaid or NJ FamilyCare -- Children's Program benefits, the CWA shall, notwithstanding the application disposition standards in N.J.A.C. 10:69-2.1, arrive at a case disposition within the presumptive eligibility period.1. If the time specified in N.J.A.C. 10:69-12.2(b)2 has elapsed without a determination being made by the CWA, the CWA shall notify the Division of Medical Assistance and Health Services of any such delay. The Division shall continue the child's presumptive eligibility until a final determination is made by the CWA.i. The CWA shall also provide the individual applying on the child's behalf with written notification of the delay prior to the expiration of the presumptive eligibility period, of the specific reasons for the delay. See N.J.A.C. 10:69-12.8(b) for the requirements related to the applicant's rights to a fair hearing due to the delay.(c) In the case of a presumptively eligible child who is determined ineligible for AFDC-related Medicaid or Medicaid Special within the presumptive eligibility period, the child's eligibility shall terminate on the date of the eligibility determination. If the child is ineligible for AFDC-related Medicaid, Medicaid Special, or any other Medicaid program, the CWA shall provide the applicant with a written notice of such denial and the reasons why, as set forth in N.J.A.C. 10:69-12.8. If appropriate, the CWA shall also refer the child to NJ FamilyCare -- Children's Program for an application for benefits.N.J. Admin. Code § 10:69-12.6
Amended by 49 N.J.R. 3729(a), effective 12/4/2017