N.J. Admin. Code § 10:69-3.27

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

Section 10:69-3.27 - Release from a State institution

(a) A parent or parent-person who is about to be released from an institutional facility (medical, mental, or correctional) may apply for AFDC-C related Medicaid.

(b) When eligibility has been established, benefits can begin upon release from the institution, providing the parent and child will be living together within 30 days of the date of issuance except in circumstances identified in (b)1 below. This application may be registered and processed up to two months before anticipated date of release.

1. When an applicant parent is being released from an institution for the mentally ill or intellectually disabled, or a correctional facility, no Health Benefits Identification (HBID) Card or HBID Emergency Services Letter shall be issued until the actual release, discharge, or parole is a matter of record and verified by the CWA, and the applicant is not adjudged or alleged to be mentally incompetent.

(c) A parent or parent-person separated from a dependent child for a period no more than 30 days prior to application, who wishes to maintain an already established home for that child with whom such parent or parent-person customarily resides, may apply for and receive a Health Benefits Identification (HBID) Card or HBID Emergency Services Letter for the child(ren) temporarily absent from the home. In this case, such parent or parent-person must indicate plans to return to the home within two months from the month in which the HBID Card or HBID Emergency Services Letter is initially issued (see N.J.A.C. 10:69-3.28 through 3.30).

(d) In the case of the return to the home of a beneficiary family by a parent, parent-person, or spouse in AFDC-C or child of eligible age in any segment, no application for Medicaid is involved.

1. If the individual will return to a home or plans to establish a home with a dependent child in the county receiving the inquiry and appears eligible for Medicaid, the CWA of that county shall register the application, assist in completion of the plan as necessary, complete the determination of eligibility and be responsible for issuance of the Health Benefits Identification (HBID) Card or HBID Emergency Services Letter (see N.J.A.C. 10:69-3.24 ).

2. If the individual is to return to a home or desires to establish a home with a dependent child in another county, the CWA receiving the inquiry shall complete an application interview and assist the individual to complete an application form. All information that the applicant can supply shall be obtained and recorded on appropriate case record forms, which shall be forwarded to the county where the family currently resides or is planning to establish a home. The county receiving the application shall process and register the application without delay.

(e) Responsibility for initial planning for the return of a patient to the community rests with the institutional authorities. When AFDC-related Medicaid is necessary and the person appears eligible, the Division of Mental Health and Addiction Services shall coordinate the application with the appropriate CWA. The Division of Mental Health and Addiction Services shall be responsible for reviewing such referrals to assure that all essential information is assembled, and for expediting the processing of an application by the appropriate CWA for final determination of eligibility.

1. The institution shall routinely complete the following forms without change, a stock supply of which shall be provided to them by the DMAHS, and shall forward copies to the CWA along with copies of staff notes pertinent to each case:

i. Form PA-12, Referral by State Mental Institution to AFDC-related Medicaid Agency; and

ii. Form DRS-8, Report of Findings by Psychiatric Diagnostic Group, where appropriate.

2. Persons under the jurisdiction of Division of Developmental Disabilities, Bureau of Field Services, shall be referred directly to the appropriate CWA.

(f) When a parent is about to be released from a veteran's hospital, the hospital shall make referral in writing, with the knowledge and consent of the veteran, to include the following minimum information: identifying data, the anticipated date of discharge, and a description of any known or tentative living arrangement following discharge.

1. In addition, the hospital shall complete, without charge, the following forms as appropriate;

i. DRS-8, Report of Findings by Diagnostic Group;

ii. Abstract of patient's hospital record, or in absence of abstract;

iii. DRS-1, Examining Physician's Report; and

iv. DRS-1A, Report of Eye Examination.

2. Thereafter, the CWA shall arrange for an application interview and shall process the application as any other.

(g) The social service staff of the institution shall assist in completing the application in accordance with N.J.A.C. 10:69-2.

1. The social service worker is responsible for prompt investigation to determine initial eligibility, including inquiry regarding any funds held by the institution or other party in a personal account for the applicant. The social service worker shall discuss available services including assistance in locating a suitable living arrangement with the applicant. The social service worker shall not send the completed referral forms to the designated CWA.

(h) The CWA shall register cases transferred from Division of Mental Health and Addiction Services within one working day. The CWA shall determine initial eligibility within 30 days and so inform in writing the social service worker that will coordinate discharge of the client.

(i) A child of eligible age or a spouse of an AFDC-C beneficiary parent who is at home on extended visit or convalescent leave from a State institution is eligible for inclusion in the AFDC-C or-F eligible unit, as appropriate.

N.J. Admin. Code § 10:69-3.27

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