Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Statewide eligibility determination
agency shall promptly notify any applicant for, or beneficiary of, the NJ
FamilyCare-Children's Program-Plan B, C and D 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 an appeal, 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).
1. For notices of action adverse to a
beneficiary, the date of mailing of the notice shall appear on the
notice.
2. 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 decisions shall
state in clear and simple language, the nature of the agency decision and an
accurate and factual basis for the decision.
1. All notices of the agency decision shall
include an explanation of the grievance process.
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 exists.
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) 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
authorized agent, 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
authorized agent, 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 that 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.
