N.J. Admin. Code § 10:69-6.9

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

Section 10:69-6.9 - Eligibility for continued Medicaid coverage

(a) When a request is made for a fair hearing within 15 days from the date of mailing of a notice of termination, Medicaid coverage shall be continued until the scheduled date of the administrative hearing or the date of the administrative review unless the beneficiary waives such entitlement or requests postponement of the scheduled hearing or review date. In the event the beneficiary elects to receive continued benefits, they will be continued pending a final decision if the ALJ or the administrative review official determines that the issue is one of fact rather than law or policy. ( 45 CFR 205.10(a)(7) )

(b) An adjournment of a hearing at the request of a beneficiary shall not prolong continuation of Medicaid coverage, unless the adjournment is due to delay caused by DMAHS, OAL, or the CWA; unavoidable causes, such as an illness on the part of the applicant/beneficiary; or the failure of the CWA to provide assistance for transportation when such assistance is required by regulations. Adjournment at the request of the CWA or by the ALJ shall not affect continued benefits.

(c) The CWA shall promptly inform the beneficiary in writing whether or not Medicaid coverage shall be continued unreduced pending a final decision.

N.J. Admin. Code § 10:69-6.9

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