Current through Register Vol. 56, No. 6, March 18, 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.
