Current through Register Vol. 56, No. 18, September 16, 2024
(a) Eligibility for
NJ FamilyCare-Children's Program under this chapter shall be redetermined, with
the completion of a redetermination form, as indicated in (a)1 and 2 below. The
redetermination form may be mailed. A face-to-face interview is not required.
1. Eligibility for NJ FamilyCare-Children's
Program-Plan A must be redetermined no later than 12 months following the month
of initial eligibility or the last redetermination.
2. Eligibility for NJ FamilyCare-Children's
Program-Plan B, C or D must be redetermined every 12 months.
3. The State provides 12 months of coverage
to enrolled children, regardless of whether the child experiences changes in
family income and/or household size that would render the child ineligible
during the 12-month period.
(b) Subsequent to the initial application,
verification is required for only those factors of eligibility which are
subject to change or for those factors for which the original verification has
become questionable.
(c) The
eligibility determination agency shall also reassess program eligibility as
follows:
1. When required on the basis of
information the eligibility determination agency has obtained previously about
anticipated change in any factors affecting the family situation or when
additional information is needed to ascertain income eligibility for the
program; and
2. Promptly after
information is obtained by the eligibility determination agency that indicates
changes that may affect program eligibility. No adverse action shall be taken
based on this information prior to the annual redetermination. If reevaluation
of eligibility considering this new information appears to result in an
increase in benefit level to the beneficiary through enrollment in a Plan that
does not require co-payments or premiums, such action shall be instituted
immediately. For example:
i. If the
information obtained indicates that the beneficiary's eligibility level shall
result in a change in benefit level from NJ FamilyCare-Children's Program-Plan
A to NJ FamilyCare-Children's Program-Plan D, the beneficiary shall remain in
Plan A until the annual redetermination date; or
ii. If the information obtained indicates
that the beneficiary's eligibility level shall result in a change in benefit
level from NJ FamilyCare-Children's Program-Plan D to NJ FamilyCare-Children's
Program-Plan A, the beneficiary shall be enrolled in Plan A
immediately.
(d) No case shall be terminated before
evaluating for continued eligibility using data available from other sources,
such as the Supplemental Nutrition Assistance or WorkFirst New Jersey
Programs.
