N.J. Admin. Code § 10:79-8.6 - Responsibilities of the eligibility determination agency

Current through Register Vol. 54, No. 7, April 4, 2022

(a) Upon receipt of the one-page PE application from the approved presumptive eligibility determination entity, the eligibility determination agency shall check for existing Medicaid, Medically Needy, or NJ FamilyCare-Children's Program eligibility. If the child is receiving Medicaid benefits, Medically Needy benefits, or NJ FamilyCare-Children's Program benefits, no further action shall be required by the county welfare agency or the Statewide eligibility determination agency.
(b) If the child is not currently receiving Medicaid, Medically Needy, or NJ FamilyCare-Children's Program benefits, the eligibility determination agency shall, notwithstanding the application disposition standards in N.J.A.C. 10:79-2.3(f), arrive at a case disposition within the presumptive eligibility period.
1. If the time period specified in 10:79-8.2(b)2 is exceeded, the presumptive 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 individual applying on the child's behalf with written notification, prior to the expiration of the presumptive eligibility period, of the specific reasons for the delay.
(c) In the case of a presumptively eligible beneficiary who is determined ineligible for NJ FamilyCare-Children's Program within the presumptive eligibility period, the child's eligibility shall terminate on the last day of the presumptive eligibility period. If the child is ineligible for NJ FamilyCare-Children's Program, the eligibility determination agency shall provide a written notice of such denial and the reasons why, as set forth in N.J.A.C. 10:79-6.


N.J. Admin. Code § 10:79-8.6
Amended by 49 N.J.R. 203(a), effective 1/17/2017

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