N.J. Admin. Code § 10:72-7.6

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:72-7.6 - Presumptive eligibility processing performed by the eligibility determination agency

(a) Upon receipt of the certificate of presumptive eligibility and a referral, if completed, from the approved presumptive eligibility determination entity, the eligibility determination agency shall check the Medicaid, Medically Needy, and NJ FamilyCare Eligibility database for existing Medicaid or NJ FamilyCare eligibility. If the child is receiving Medicaid benefits, Medically Needy benefits or NJ FamilyCare benefits, no further action shall be required by the eligibility determination agency.

(b) If the child is not currently receiving Medicaid or NJ FamilyCare benefits, the eligibility determination entities shall, notwithstanding the application disposition standards in 10:72-2.1(d), arrive at a case disposition within the presumptive eligibility period.

1. If the time period specified in 10:72-7.2(b)2 is exceeded, the eligibility determination agency shall notify the Division of Medical Assistance and Health Services of any such delay. The Division shall continue the child's presumptive eligibility until a final determination is made.

2. The eligibility determination agency shall also provide the applicant written notification of the specific reason(s) for the delay, prior to the expiration of the presumptive eligibility period in accordance with 10:72-7.8(b).

(c) In the case of a presumptively eligible beneficiary who is determined ineligible for New Jersey Care... Special Medicaid Programs within the presumptive eligibility period, the child's eligibility shall terminate on the date of the eligibility determination. If the child is determined ineligible for any other Medicaid program, Medically Needy, or NJ FamilyCare, the eligibility determination agency shall provide a written notice of such denial and the reasons why, as set forth in 10:72-7.8.

N.J. Admin. Code § 10:72-7.6

Amended by R.2008 d.30, effective 1/22/2008.
See: 39 N.J.R. 3704(a), 40 N.J.R. 723(a).
Substituted "FamilyCare" for "KidCare" throughout; and in (a), deleted the comma following "Medically Needy benefits" and inserted "the" preceding the last occurrence of "eligibility".