(b) A
temporary visit by either the beneficiary family or any member thereof shall
not be considered to be a change of county residence until that visit has
continued for more than a three-month period (see
N.J.A.C.
10:69-3.28 and 3.30).
1. Whenever it is determined that a
beneficiary family whose application has not been validated has changed or is
planning to change its residence from one county to another, the CWA of origin
shall continue assistance while completing the validation, subject to the time
limits set forth in
N.J.A.C.
10:69-2.15, then transfer the case without
delay to the receiving county.
2.
Whenever it is determined that a beneficiary family whose application has been
validated is planning to change its residence from one county to another, it
shall be the responsibility of the CWA directors of the two counties concerned
to effect the transfer without interruption of Medicaid coverage.
3. The county of origin shall initiate and
the receiving county shall, on request, immediately cooperate in accomplishing
a full investigation of the circumstances surrounding the move. If the move is
permanent, each county shall execute its respective responsibilities in
accordance with this paragraph.
i. The county
of origin has the responsibility to:
(1)
Transfer, within five working days from the date it is notified of the actual
move, a copy of pertinent case material to the receiving county. Such material
shall include, at a minimum, a copy of the first application and the most
recent PA-1J form; the most recent 105A and B forms; Social Security numbers or
copies of SS-5 forms; all birth verifications; and, where ongoing recovery of
overpayments is involved, the amounts and net balances;
(2) Forward promptly to the receiving county
copies of any other material mutually identified as necessary for case
administration; and
(3) Instruct
the client to contact the receiving county immediately to arrange for filing an
application to transfer the Medicaid coverage.
ii. The receiving county has, except as noted
in 10:69-7.6, the responsibility to:
(1) Communicate with the client if case
material is received prior to client contact and the client's new address is
known. Such communication shall invite the client to make application to ensure
receipt of uninterrupted Medicaid coverage;
(2) Grant Medicaid coverage (provided
application to transfer has been made) for the next month if initial case
material has been received before the 10th of the month;
(3) Grant Medicaid coverage (provided
application to transfer has been made) for the second month after the month of
initial receipt of case records when such records are received on or after the
10th of the month; and
(4) Notify
immediately the county of origin of the date case records were received and the
date Medicaid coverage shall be granted.
iii. The welfare of the clients shall not be
adversely affected and disagreement or other administrative difficulty between
the counties shall not prejudice their right to uninterrupted Medicaid
coverage. Any adverse action resulting from transfer requires timely notice
(see N.J.A.C. 10:69-6). If the receiving county is unable to verify
eligibility within prescribed time limits, as stated in (b)3ii(2) or (3) above,
it shall accept case responsibility in accordance with (b)3ii above and grant
Medicaid coverage until such verification is completed (see N.J.A.C. 10:69-3
).
iv. When a change in residence
results in loss of Medicaid coverage, the receiving county shall send timely
notice of such change to the client and a copy to the county of origin
consistent with the requirements of N.J.A.C. 10:69-6. It is the receiving
county's responsibility to send adverse notice, when necessary, after
determining the client's circumstances following the change in county
residence. In the event of a request for a fair hearing within 15 days of the
mailing of such notice, the county of origin shall be notified and shall be
responsible for Medicaid coverage pending the fair hearing.
(1) Whenever the beneficiary is entitled to
receive Medicaid until the final hearing decision, the county of origin shall
issue the Health Benefits Identification (HBID) Card and/or HBID Emergency
Services Letter until the decision is rendered. The receiving county shall then
immediately accept case responsibility.