N.J. Admin. Code § 10:70-2.5

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:70-2.5 - Redetermination of eligibility

(a) Eligibility for the Medically Needy Program shall be redetermined as follows:

1. When required, on the basis of information the county board of social services (CBOSS) has obtained previously about anticipated changes in the case situation, or when additional information is necessary to adjust the best estimate of income when such income is subject to significant fluctuation;

2. Promptly, after information is obtained by the CBOSS which indicates changes in the case circumstances that may affect program eligibility or the amount of benefits received under the Program;

3. For cases not subject to medical spend-down, a full redetermination of program eligibility, no later than six months from the date eligibility was first established or from the date of the last full redetermination;

4. For cases subject to spend-down, a full redetermination of program eligibility, by the completion of the current prospective six-month budget period.

(b) For redeterminations of eligibility required by (a)1 and 2 above, the completion of a Form PA-1G-NJR2 (Redetermination Form) and a face-to-face interview are required only if, on the basis of the information obtained, in conjunction with existing case information, the CBOSS is unable to arrive at a decision regarding eligibility or ineligibility.

(c) Full redeterminations of eligibility ((a)3 and 4 above) require the completion of a Form PA-1G-NJR2 (Redetermination Form). The CBOSS may require that the form be completed during a face-to-face interview. However, at the option of the CBOSS, and with the approval of the beneficiary, the face-to-face interview may be eliminated. Form PA-1G-NJR2 (Redetermination Form) may be mailed to and completed by the beneficiary and mailed to the CBOSS. All factors of eligibility subject to change (with the exception of disability and blindness factors; see N.J.A.C. 10:70-2.6) must be verified or reverified.

1. When a loss of assistance will result, the face-to-face interview shall be required, unless the agency documents a clear refusal by the beneficiary to have a face-to-face meeting. Before benefits are terminated, a beneficiary shall be offered a face-to-face home visit. The visit shall not be required to be in the office, but at the beneficiary's request, in the home.

(d) The responsibilities of the client(s) in the process of eligibility redetermination are the same as those delineated for program applicants at N.J.A.C. 10:70-2.1(c).

N.J. Admin. Code § 10:70-2.5

Amended by R.2000 d.396, effective 10/2/2000.
See: 32 N.J.R. 2420(a), 32 N.J.R. 3570(a).
In (a) and (b), substituted references to CBOSS for references to welfare agencies; in (b), substituted a reference to Redetermination Forms for a reference to new application forms; and rewrote (c).