New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 69 - AFDC-RELATED MEDICAID
Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN
Section 10:69-12.8 - Notification and fair hearing rights

(a) For a presumptively eligible child who is subsequently determined ineligible for AFDC-related Medicaid benefits, Medicaid Special benefits, or any other Medicaid or NJ FamilyCare -- Children's Program benefits program, the CWA:

(b) For a presumptively eligible child whose eligibility for AFDC-related Medicaid or Medicaid Special has not yet been determined within the presumptive eligibility period, in accordance with N.J.A.C. 10:69-2.15, the CWA shall provide the child, if appropriate, 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 AFDC-related Medicaid or Medicaid Special application processing. The presumptively eligible beneficiary shall be entitled to a fair hearing based on the CWA's failure to determine the child's AFDC-related Medicaid or Medicaid Special eligibility or ineligibility within the application processing period.

(c) A child denied presumptive eligibility by an approved presumptive eligibility determination entity is not entitled to adequate notice of that determination nor entitled to a fair hearing on that action. The denial of presumptive eligibility shall not affect the child's (if appropriate), parent's, guardian's or caretaker relative's right to apply for AFDC-related Medicaid or Medicaid Special on behalf of the child and to receive a formal determination of eligibility or ineligibility relative to that determination.