N.J. Admin. Code § 10:69-5.2

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

Section 10:69-5.2 - Requirements for periodic redetermination

(a) Redetermination is a review of factors affecting AFDC-related Medicaid eligibility, including, but not limited to, continued parental deprivation, or changes in income. At the redetermination, the parent(s) shall complete an application for continuation for Medicaid. If a redetermination is not conducted and the CWA is responsible, the right of the client to continued Medicaid shall not be jeopardized.

(b) For beneficiaries of AFDC-related Medicaid, all factors of eligibility shall be redetermined at least every 12 months. No case shall be terminated before evaluating eligibility, using data available from other sources, such as the Supplemental Nutrition Assistance Program (SNAP) or Work First programs. All cases determined ineligible for AFDC-Medicaid shall be screened for eligibility under all other program options. Referrals shall be coordinated to ensure that continuous coverage of benefits is available to the beneficiary, as applicable.

(c) Redeterminations shall be conducted in each case at least once every 12 months, but, at the beneficiary's option, the beneficiary may mail in the redetermination form to the CWA.

(d) It is the responsibility of the CWA to maintain a control file to assure that redeterminations are undertaken and acted upon at intervals as prescribed by this section. The redetermination time interval shall be contingent upon the month in which the beneficiary's permanent Health Benefits Identification (HBID) Card is issued, rather than on such factors as the date of application or final validation of eligibility.

N.J. Admin. Code § 10:69-5.2

Amended by 49 N.J.R. 3729(a), effective 12/4/2017