N.J. Admin. Code § 10:72-7.8

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

Section 10:72-7.8 - Notification and fair hearing rights

(a) For a presumptively eligible child who is subsequently determined ineligible for Medicaid or NJ FamilyCare benefits:

1. The eligibility determination agency shall not be required to provide either timely or adequate notice for the end of the presumptive eligibility period. The presumptively eligible beneficiary shall not have any right to a fair hearing based on the termination of presumptive eligibility; and

2. The eligibility determination agency shall provide the child's parent, guardian or caretaker relative a notice of denial of the child's Medicaid application in accordance with N.J.A.C. 10:72-5.1. The presumptively eligible beneficiary shall have the right to apply for a fair hearing in accordance with N.J.A.C. 10:72-5.1 based on the denial of the application.

(b) For a presumptively eligible child whose eligibility for Medicaid or NJ FamilyCare has not yet been determined within the presumptive eligibility period, in accordance with N.J.A.C. 10:72-2.1(d)3, the eligibility determination agency shall provide the parent, guardian or caretaker relative of the presumptively eligible child with written notification prior to the expiration of the presumptive eligibility period, setting forth the specific reasons for the delay in the application processing. The presumptively eligible beneficiary shall be entitled to a fair hearing based on the eligibility determination agency's failure to determine the child's Medicaid eligibility or ineligibility within the application processing period.

(c) A child denied presumptive eligibility by an approved presumptive eligibility determination entity shall not be entitled to adequate notice of that determination and shall not be entitled to a fair hearing on that action. The denial of presumptive eligibility shall not affect the parent's, guardian's or caretaker relative's right to apply for Medicaid or NJ FamilyCare on behalf of the child and to receive a formal determination of eligibility or ineligibility.

N.J. Admin. Code § 10:72-7.8

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 (b), deleted the comma following "guardian".