New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 3 - ESTABLISHING PROGRAM ELIGIBILITY IN AFDC-RELATED MEDICAID › Section 10:69-3.24 - Change of county residence

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Responsibility
				for AFDC-related Medicaid, and Medicaid extension case management and payment,
				shall be transferred from one county to the other when a beneficiary family
				moves to another county.
(b) A
				temporary visit by either the beneficiary family or any member thereof shall
				not be considered to be a change of county residence until that visit has
				continued for more than a three-month period (see
				N.J.A.C.
				10:69-3.28 and 3.30).
1. Whenever it is determined that a
				beneficiary family whose application has not been validated has changed or is
				planning to change its residence from one county to another, the CWA of origin
				shall continue assistance while completing the validation, subject to the time
				limits set forth in
				N.J.A.C.
				10:69-2.15, then transfer the case without
				delay to the receiving county.
2.
				Whenever it is determined that a beneficiary family whose application has been
				validated is planning to change its residence from one county to another, it
				shall be the responsibility of the CWA directors of the two counties concerned
				to effect the transfer without interruption of Medicaid coverage.
3. The county of origin shall initiate and
				the receiving county shall, on request, immediately cooperate in accomplishing
				a full investigation of the circumstances surrounding the move. If the move is
				permanent, each county shall execute its respective responsibilities in
				accordance with this paragraph.
i. The county
				of origin has the responsibility to:
(1)
				Transfer, within five working days from the date it is notified of the actual
				move, a copy of pertinent case material to the receiving county. Such material
				shall include, at a minimum, a copy of the first application and the most
				recent PA-1J form; the most recent 105A and B forms; Social Security numbers or
				copies of SS-5 forms; all birth verifications; and, where ongoing recovery of
				overpayments is involved, the amounts and net balances;
(2) Forward promptly to the receiving county
				copies of any other material mutually identified as necessary for case
				administration; and
(3) Instruct
				the client to contact the receiving county immediately to arrange for filing an
				application to transfer the Medicaid coverage.
ii. The receiving county has, except as noted
				in 10:69-7.6, the responsibility to:
(1) Communicate with the client if case
				material is received prior to client contact and the client's new address is
				known. Such communication shall invite the client to make application to ensure
				receipt of uninterrupted Medicaid coverage;
(2) Grant Medicaid coverage (provided
				application to transfer has been made) for the next month if initial case
				material has been received before the 10th of the month;
(3) Grant Medicaid coverage (provided
				application to transfer has been made) for the second month after the month of
				initial receipt of case records when such records are received on or after the
				10th of the month; and
(4) Notify
				immediately the county of origin of the date case records were received and the
				date Medicaid coverage shall be granted.
iii. The welfare of the clients shall not be
				adversely affected and disagreement or other administrative difficulty between
				the counties shall not prejudice their right to uninterrupted Medicaid
				coverage. Any adverse action resulting from transfer requires timely notice
				(see N.J.A.C. 10:69-6 ). If the receiving county is unable to verify
				eligibility within prescribed time limits, as stated in (b)3ii(2) or (3) above,
				it shall accept case responsibility in accordance with (b)3ii above and grant
				Medicaid coverage until such verification is completed (see N.J.A.C. 10:69-3
				).
iv. When a change in residence
				results in loss of Medicaid coverage, the receiving county shall send timely
				notice of such change to the client and a copy to the county of origin
				consistent with the requirements of N.J.A.C. 10:69-6. It is the receiving
				county's responsibility to send adverse notice, when necessary, after
				determining the client's circumstances following the change in county
				residence. In the event of a request for a fair hearing within 15 days of the
				mailing of such notice, the county of origin shall be notified and shall be
				responsible for Medicaid coverage pending the fair hearing.
(1) Whenever the beneficiary is entitled to
				receive Medicaid until the final hearing decision, the county of origin shall
				issue the Health Benefits Identification (HBID) Card and/or HBID Emergency
				Services Letter until the decision is rendered. The receiving county shall then
				immediately accept case responsibility.