N.J. Admin. Code § 10:69-3.24

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:69-3.24 - Change of county residence

(a) Responsibility for AFDC-related Medicaid, and Medicaid extension case management and payment, shall be transferred from one county to the other when a beneficiary family moves to another county.

(b) A temporary visit by either the beneficiary family or any member thereof shall not be considered to be a change of county residence until that visit has continued for more than a three-month period (see N.J.A.C. 10:69-3.28 and 3.30).

1. Whenever it is determined that a beneficiary family whose application has not been validated has changed or is planning to change its residence from one county to another, the CWA of origin shall continue assistance while completing the validation, subject to the time limits set forth in N.J.A.C. 10:69-2.15, then transfer the case without delay to the receiving county.

2. Whenever it is determined that a beneficiary family whose application has been validated is planning to change its residence from one county to another, it shall be the responsibility of the CWA directors of the two counties concerned to effect the transfer without interruption of Medicaid coverage.

3. The county of origin shall initiate and the receiving county shall, on request, immediately cooperate in accomplishing a full investigation of the circumstances surrounding the move. If the move is permanent, each county shall execute its respective responsibilities in accordance with this paragraph.

i. The county of origin has the responsibility to:

(1) Transfer, within five working days from the date it is notified of the actual move, a copy of pertinent case material to the receiving county. Such material shall include, at a minimum, a copy of the first application and the most recent PA-1J form; the most recent 105A and B forms; Social Security numbers or copies of SS-5 forms; all birth verifications; and, where ongoing recovery of overpayments is involved, the amounts and net balances;

(2) Forward promptly to the receiving county copies of any other material mutually identified as necessary for case administration; and

(3) Instruct the client to contact the receiving county immediately to arrange for filing an application to transfer the Medicaid coverage.

ii. The receiving county has, except as noted in 10:69-7.6, the responsibility to:

(1) Communicate with the client if case material is received prior to client contact and the client's new address is known. Such communication shall invite the client to make application to ensure receipt of uninterrupted Medicaid coverage;

(2) Grant Medicaid coverage (provided application to transfer has been made) for the next month if initial case material has been received before the 10th of the month;

(3) Grant Medicaid coverage (provided application to transfer has been made) for the second month after the month of initial receipt of case records when such records are received on or after the 10th of the month; and

(4) Notify immediately the county of origin of the date case records were received and the date Medicaid coverage shall be granted.

iii. The welfare of the clients shall not be adversely affected and disagreement or other administrative difficulty between the counties shall not prejudice their right to uninterrupted Medicaid coverage. Any adverse action resulting from transfer requires timely notice (see N.J.A.C. 10:69-6 ). If the receiving county is unable to verify eligibility within prescribed time limits, as stated in (b)3ii(2) or (3) above, it shall accept case responsibility in accordance with (b)3ii above and grant Medicaid coverage until such verification is completed (see N.J.A.C. 10:69-3 ).

iv. When a change in residence results in loss of Medicaid coverage, the receiving county shall send timely notice of such change to the client and a copy to the county of origin consistent with the requirements of N.J.A.C. 10:69-6. It is the receiving county's responsibility to send adverse notice, when necessary, after determining the client's circumstances following the change in county residence. In the event of a request for a fair hearing within 15 days of the mailing of such notice, the county of origin shall be notified and shall be responsible for Medicaid coverage pending the fair hearing.

(1) Whenever the beneficiary is entitled to receive Medicaid until the final hearing decision, the county of origin shall issue the Health Benefits Identification (HBID) Card and/or HBID Emergency Services Letter until the decision is rendered. The receiving county shall then immediately accept case responsibility.

(c) Those cases that are in Medicaid extension only shall also be transferred to the new county of residence when the family moves from the county of origin in the same manner as active AFDC-related Medicaid cases. The procedures established at N.J.A.C. 10:69-3.26(b) are to be followed when transferring a case in Medicaid extension (see also N.J.A.C. 10:69-5.13 ).

N.J. Admin. Code § 10:69-3.24

Amended by 49 N.J.R. 3729(a), effective 12/4/2017