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