N.J. Admin. Code § 10:72-6.6

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

Section 10:72-6.6 - Notification and fair hearing rights

(a) For a presumptively eligible pregnant woman who is subsequently determined ineligible for Medicaid benefits:

1. The county welfare agency is not required to provide either timely or adequate notice for the end of the presumptive eligibility. The pregnant woman has no right to a fair hearing based on the termination of her presumptive eligibility.

2. The county welfare agency shall provide the applicant notice of denial of her Medicaid application in accordance with N.J.A.C. 10:72-5.1. The pregnant woman has the right to apply for a fair hearing based on the denial of her Medicaid application.

(b) For a presumptively eligible pregnant woman whose eligibility for Medicaid has not yet been determined within the presumptive eligibility period:

1. The county welfare agency is not required to provide either adequate or timely notice for the termination of her period of presumptive eligibility. The pregnant woman has no right to a fair hearing based on the termination of presumptive eligibility.

2. In accordance with N.J.A.C. 10:72-2.1(d)3, the county welfare agency shall provide the pregnant woman with written notification prior to the expiration of the presumptive eligibility period, setting forth the specific reasons for the delay in the Medicaid application processing. The pregnant woman is entitled to a fair hearing based on the county welfare agency's failure to determine her Medicaid eligibility or ineligibility within the application processing period.

(c) A woman denied presumptive eligibility by a qualified provider is neither entitled to adequate notice of that determination nor entitled to a fair hearing on that action. The denial of presumptive eligibility shall not affect the woman's right to apply for Medicaid at the county welfare agency and to receive a formal determination of eligibility or ineligibility.

N.J. Admin. Code § 10:72-6.6

Amended by R.1992 d.10, effective 1/6/1991.
See: 23 New Jersey Register 2827(a), 24 New Jersey Register 100(a).
Recodified from 6.5.
In (a): revised "eligible" to "ineligible for Medicaid benefits ...".
In subsection (b) and (b)2: revised text to "presumptive eligibility period" from "45-day period."