New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL
Subchapter 5 - ADMINISTRATIVE REQUIREMENTS
Section 10:72-5.1 - Notice of the county welfare agency decision
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The county welfare agency shall promptly notify any applicant for, or beneficiary of, the Medicaid program in writing of any agency decision affecting the applicant or beneficiary. When a decision relates to any adverse action which may entitle a beneficiary to a fair hearing, the action may not be implemented until at least 10 days after the mailing of the notice (see (e) below for exceptions to the 10-day notice requirement).
(b) All notices of agency decision shall state in clear and simple language, the nature of the agency decision and an accurate and factual legal basis for the decision.
(c) All notices of denial or termination shall include an explicit statement of the reason for program ineligibility and (except in the case of the death of an applicant or beneficiary) advise of the right to reapply whenever the applicant or beneficiary believes that circumstances have changed such that the reason for program ineligibility no longer exist.
(d) When the processing of an application will be delayed beyond the standards for disposition of an application as set forth in 10:72-2.1(d), notice shall be mailed prior to the expiration of the disposition period notifying the applicant of the delay and the reasons for it.
(e) The 10-day notice requirement for actions adverse to a program beneficiary need not be adhered to when: