N.J. Admin. Code § 10:72-6.4

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

Section 10:72-6.4 - Responsibility of the county welfare agency

(a) Upon receipt of the Certification of Presumptive Eligibility (FD-334) and a properly completed New Jersey Care Pregnant Women and Infants Application Referral (FD-335) from the qualified provider, the county welfare agency shall:

1. Check the Medicaid and Medically Needy Eligibility File for existing Medicaid eligibility.

i. If the beneficiary is receiving Medicaid benefits as an AFDC child or adult, a Medicaid Special individual, or a New Jersey Care or Medically Needy pregnant woman, no further action shall be required by the county welfare agency.

ii. If the beneficiary is receiving Medicaid benefits as a Medically Needy child or Medically Needy disabled adult, a separate case shall be established which would entitle the beneficiary to receive additional prenatal services available to Medically Needy pregnant women. In such instances, the county welfare agency shall schedule a face-to-face interview with the beneficiary to verify all factors of eligibility before a final determination of eligibility or ineligibility is made.

iii. If the beneficiary is an AFDC adult or child, and there are indications of a change in circumstances, such as a marriage of the pregnant woman, the county welfare agency may schedule a face-to-face interview with the beneficiary to verify all factors of continued eligibility as an AFDC case before a final determination of eligibility or ineligibility is made. However, she cannot be found ineligible for Medicaid solely because she does not meet AFDC standards for cash assistance, but must be evaluated for eligibility for other Medicaid programs without regard to any changes which occurred after the determination of presumptive eligibility.

2. Notwithstanding the application disposition standards in N.J.A.C. 10:72-2.1(d), the county welfare agency shall arrive at a case disposition within the presumptive eligibility period.

i. The policy at N.J.A.C. 10:72-2.1(d)2 concerning delayed application processing applies equally to the processing of the application of a presumptively eligible pregnant woman. In the event the processing standard is exceeded, the qualified provider shall be notified that the processing of the woman's Medicaid application has been delayed. The Division of Medical Assistance and Health Services shall also be notified of any such delay, and shall take steps to continue her presumptive eligibility until a final determination is made.

ii. In the event the processing of the application is delayed beyond the presumptive eligibility period, the county welfare agency shall provide the applicant with written notification prior to its expiration setting forth the specific reasons for the delay.

3. In the case of a presumptively eligible pregnant women who is determined ineligible for Medicaid within the presumptive eligibility period, the woman's eligibility shall terminate as of the day of the ineligibility determination.

N.J. Admin. Code § 10:72-6.4

New Rule, R.1992 d.10, effective 1/6/1992.
See: 23 New Jersey Register 2827(a), 24 New Jersey Register 100(a).
Existing 6.4 recodified to 6.5.
Amended by R.1992 d.364, effective 9/21/1992.
See: 24 New Jersey Register 2145(a), 24 New Jersey Register 3343(a).
Stylistic change.
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).
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.