10:71-8.1 Other agency responsibilities
(a) Determination of continuing eligibility: The eligibility of each case shall be redetermined
at least once every 12 months. This redetermination provides an opportunity to evaluate the
total situation and enables the eligibility worker to ascertain whether the individual's eligibility
has changed.
1. It shall be the agency's responsibility to review indications of ineligibility as they occur
and to discontinue Medicaid Only eligibility when appropriate and without delay. The agency
shall notify each applicant/beneficiary of any agency decision that relates to his or her
eligibility status in accordance with the provisions of (d) below and 8.3.
2. The individual, or his or her authorized representative, shall execute a formal written
application, Form PA-1G, Application and Affidavit for Medical Assistance Only (Aged, Blind,
or Disabled), for continuance of assistance at least once every 12 months.
(b) Process of redetermination:
1. Redeterminations of eligibility require the completion of Form PA-1G-NJR2
(Redetermination Form). The CBOSS may require that the form be completed during a faceto-
face interview. However, at the option of the CBOSS, and with the approval of the
beneficiary, the face-to-face interview may be eliminated. Form PA-1G-NJR2
(Redetermination Form) may be mailed to and completed by the beneficiary and mailed to
the CBOSS. All factors of eligibility subject to change (with the exception of disability and
blindness factors) must be verified or reverified.
i. When a loss of assistance will result, the face-to-face interview shall be required, unless
the agency documents a clear refusal by the beneficiary to have a face-to-face meeting.
Before benefits are terminated, a beneficiary shall be offered a face-to-face home visit. The
visit shall not be required to be in the office, but at the beneficiary's request, in the home.
2. Redetermination of financial and resource eligibility: The eligibility worker shall review all
eligibility factors in accordance with the provisions set forth in N.J.A.C. 10:71-3, 4, and 5.
Particular attention shall be directed to identification of any changes in resources and
income.
3. Completion of the Medicaid Eligibility Worksheet: It is the responsibility of the eligibility
worker to complete a new Form PA-1E when eligibility is to be continued, or terminated. A
PR-1 Statement of Income Available for Long Term Care Facility Payment should be
prepared for persons in institutions only when there is a change with regard to the amount
of income available for medical reimbursement.
4. Need for institutional care: Official review of this factor on a routine basis is not required,
but when medical or social evidence indicates that specific determination should be made,
the CBOSS shall institute such an investigation.
(c) Recording and recommendation: A Summary Report, Form PA-2D, concerning all
pertinent information shall be completed for each contact with the individual, whenever it
occurs. Whenever a change in circumstances affects any facet of eligibility, a Medicaid
Eligibility Worksheet (Form PA-1E) shall be prepared. The summary shall clearly state the basis for any termination of eligibility. Following each redetermination of eligibility, it is the
responsibility of the eligibility worker to recommend that eligibility be continued or
terminated.
(d) Notice of agency decision: Each applicant/beneficiary shall receive written notice of any
agency decision which relates to his or her eligibility status at least 10 days prior to any
change in his or her eligibility status.