Current through Register Vol. 56, No. 18, September 16, 2024
(a)
The eligibility determination agency shall promptly notify any applicant for,
or beneficiary of, the NJ FamilyCare-Children's Program-Plan A 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.
1. For notices of
action adverse to a beneficiary, the date of mailing of the notice must appear
on the notice.
2. Notices of any
eligibility determination agency action must contain the name, address, and
telephone number of the legal services agency serving that county.
3. In the case of an applicant or beneficiary
who cannot be located, the notice shall be mailed to his or her last known
address.
(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.
1. All notices of the agency decision shall
include an explanation of the right to a fair hearing.
2. Notices of agency decisions adverse to the
applicant or beneficiary shall include the citation and title of the
regulations upon which the agency decision is based.
(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.
1. If eligibility is being
denied or terminated due to household income exceeding 350 percent of the
Federal Poverty Level, then the notice of denial or termination shall include
contact information regarding the NJ FamilyCare Advantage program.
(d) When the processing of an
application will be delayed beyond the standards for disposition of an
application as set forth in
10:79-2.3(f),
notice shall be mailed prior to the expiration of the disposition period
notifying the applicant of the delay and reasons for it.
(e) The 10-day notice requirement for actions
adverse to a program beneficiary need not be adhered to when:
1. The eligibility determination agency has
factual information confirming the death of a beneficiary;
2. The eligibility determination agency
receives a clear written statement, signed by the emancipated child, or the
caretaker adult that he or she no longer wishes to receive program benefits, or
which gives information indicating a change in circumstances which requires a
termination or reduction in benefits, and the emancipated child, or the
caretaker adult has indicated in writing that he or she understands that this
must be the consequence of supplying such information;
3. The beneficiary's whereabouts are unknown
and agency mail directed to him or her has been returned by the postal service
indicating no forwarding address;
4. The beneficiary has been accepted for
public or medical assistance in another state and the fact has been confirmed
by the eligibility determination agency; or
5. A beneficiary child has been removed from
the home as a result of a judicial determination or voluntarily placed in
foster care by his or her legal guardian.
