Current through Register Vol. 56, No. 18, September 16, 2024
(a)
Deprivation under AFDC-C-related Medicaid can result from death, incapacity or
continued absence of one or both natural or adoptive parents.
(b) The eligibility worker shall inform the
applicant of the need to prove the death of the eligible child(ren)'s parent(s)
and of the sources available for such documentation (see
10:69-3.3) .
(c) Physical or mental incapacity of a parent
shall be deemed to exist when both parents are in the home and one has a
physical or mental defect, illness, or impairment. The incapacity shall be
supported by competent medical testimony and must be of such a nature as to
reduce substantially or eliminate the parent's ability to support or care for
the eligible child and be expected to last for at least 30 days.
1. Evidence of incapacity without need for
further development includes:
i. The
applicant is receiving benefits not due to age alone under the Supplemental
Security Income program (SSI) administered by the Social Security
Administration (SSA);
ii. The
applicant is receiving Social Security disability insurance benefits as the
Federal RSDI program administered by the Social Security Administration;
or
iii. The applicant is receiving
inpatient care in a medical facility and the attending physician indicates in
writing that such care shall be required for at least 30 days.
2. If the applicant claims to be
in immediate need and none of the factors in (c)1 above exist, he or she shall
be evaluated for AFDC-F.
3. If the
applicant receiving AFDC-related Medicaid under the AFDC-F segment is not found
to be incapacitated, the CWA will so notify the applicant promptly of the
denial of the application as to incapacity. (See
N.J.A.C.
10:69-2.15.)
Although the notice will show no grant change as a result of
the denial, the applicant nonetheless has a right to a fair hearing.
4. To establish eligibility for
persons not covered by (c)1 above, see N.J.A.C. 10:69-3.
5. Where appropriate, the eligibility worker
shall review with the applicant the desirability of applying for SSI. The
eligibility worker shall explain to the applicant that if he or she decides to
apply he or she shall be required to sign Forms PA-30 and PA-30A.
(d) Continued absence of the
parent from the home constitutes deprivation of parental support or care.
Absence shall be considered continued when it interrupts or terminates the
parent's functioning as a provider of maintenance, physical care, or guidance
for the child, and the known or indefinite duration of the absence precludes
the parent's performance of his or her function in planning for the present
support or care of the child. If these conditions exist, the parent may be
absent for any reason, and he or she may have left only recently or sometime
previously.
1. When information is received
that an AFDC-related Medicaid beneficiary and his or her children are "living
with" or being "frequently visited" by the allegedly absent parent of one or
more of the children, the CWA shall immediately commence a comprehensive
investigation of the family situation. Such investigation shall include:
i. Checking with appropriate authorities, for
example, the Motor Vehicle Commission, the Postal Service, utility and
telephone companies, employers, and landlords, to ascertain whether the
allegedly absent parent's address is the same as the beneficiary's address;
ii. Obtaining information from
collateral sources to determine whether the parent is living at the
beneficiary's address, or, if he or she only visits, how often and for how
long. (Affidavits of these circumstances or, more importantly, agreements to
testify, if necessary, should be obtained.);
iii. Observing the family home (on more than
one occasion);
iv. Interviewing
both the AFDC-related Medicaid beneficiary and the allegedly absent parent as
to the status of their living arrangements, the frequency, duration, and nature
of his or her visits to the family home, the present financial arrangements
between them, confronting them with the information previously obtained from
independent sources, and permitting them an opportunity to admit, deny,
contradict or explain any or all of it; and
v. Following up all leads obtained during the
interview, to confirm or disprove assertions made during the
interview.
2. When the
investigation is completed, the CWA shall determine whether the parent is
continually absent. If it is determined that the parent is residing with the
eligible unit, such parent is not to be considered continually absent. If it
has been determined that the parent is not residing with the eligible unit, in
order to establish that such parent is not to be considered continually absent,
evidence must exist of the parent's provision of three parental functions:
maintenance, physical care, and guidance to the child(ren). Unless all three
parental functions are present, the "absent" parent shall be considered
continually absent. Evidence supporting the determination of continued absence
shall be fully documented in the case record.
3. If the CWA is convinced that the parent is
not absent and the family is no longer eligible for AFDC-C-related Medicaid
based on deprivation of parental support or care, the CWA shall terminate
AFDC-related Medicaid. The family shall be evaluated for eligibility for any
other Medicaid program before termination. If termination is necessary, the
adverse action notice shall give as the reason for the action that the "absent"
parent is either living in the home or that his or her presence in the home is
such that he or she can no longer be considered to be continually absent
therefrom, and cite the appropriate regulations.
(e) When continued absence as defined in (d)
above exists, eligibility for AFDC-F Medicaid ceases. The family shall be
evaluated for AFDC-C-related Medicaid.
1. In
situations where the parent is to be incarcerated, hospitalized,
institutionalized or incapacitated for a period beyond 30 days, eligibility for
AFDC-F-related Medicaid ceases. The remaining members of the family shall be
evaluated for AFDC-C-related Medicaid.
