N.J. Admin. Code § 10:72-2.5

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:72-2.5 - Redetermination of eligibility

(a) Eligibility for Medicaid under this chapter shall be redetermined, including the completion of the appropriate application form, as follows:

1. For a pregnant woman, eligibility need not be redetermined until the birth of her child. Upon the birth of the child, the newborn shall remain eligible for a period of not less than 60 days from his or her birth and up to one year, so long as the mother remains eligible, or would remain eligible if pregnant, and the child resides with her, whether or not application has been made.

2. For an aged, blind, or disabled individual, including a disabled child, eligibility must be redetermined no later than 12 months following the month of initial eligibility or the last redetermination using Form PA-1G-NJR2 (Redetermination Form). The CBOSS may require that the form be completed during a face-to-face interview. However, at the option of the CBOSS, and with the approval of the beneficiary, the face-to-face interview may be eliminated. Form PA-1G-NJR2 (Redetermination Form) may be mailed to and completed by the beneficiary and mailed to the CBOSS.

i. When a loss of assistance will result, the face-to-face interview shall be required, unless the agency documents a clear refusal by the beneficiary to have a face-to-face meeting. Before benefits are terminated, a beneficiary shall be offered a face-to-face home visit. The visit shall not be required to be in the office, but at the beneficiary's request, in the home.

(b) The county board of social services shall reassess program eligibility as follows:

1. When required on the basis of information the county board of social services has obtained previously about anticipated change in the case situation or when additional information is needed to ascertain income eligibility for the program.

2. Promptly after information is obtained by the county board of social services which indicates changes in the case circumstances that may affect program eligibility or post-eligibility treatment of income.

N.J. Admin. Code § 10:72-2.5

Emergency Adoption, R.1988 d.96, effective 3/7/1988.
See: 20 New Jersey Register 548(a).
Added (a)3.
Amended by R.1991 d.483, effective 10/7/1991.
See: 23 New Jersey Register 1889(a), 23 New Jersey Register 3028(a).
In (a)1: revised text to conform with Federal requirements to expand eligibility for newborn children of Medicaid eligible women.
Amended by R.1992 d.364, effective 9/21/1992.
See: 24 New Jersey Register 2145(a), 24 New Jersey Register 3343(a).
Clarification added to (b)2 to include treatment of income after determination of eligibility.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 New Jersey Register 713(a).
In (a), substituted "disabled or blind children, other than newborns born to an otherwise eligible pregnant woman" for "children, other than newborns" in 2.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 New Jersey Register 713(a), 30 New Jersey Register 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2000 d.396, effective 10/2/2000.
See: 32 New Jersey Register 2420(a), 32 New Jersey Register 3570(a).
Rewrote (a); and in (b), substituted "board of social services" for "welfare agency" throughout.