- If a Medicaid beneficiary is no longer eligible for the category in which the beneficiary is enrolled, the Medicaid agency must consider whether the beneficiary may be eligible under one or more other eligibility groups covered by the state.
- If the Medicaid agency identifies another eligibility group for which a beneficiary may be eligible, but requires additional information to make the determination, it must request additional information and give the beneficiary a reasonable amount of time to provide the information.
- If the agency is not able to complete a determination of eligibility on another basis before the end of the eligibility period, it must make the determination as expeditiously as possible.
- The Medicaid agency may not terminate coverage and must continue to furnish benefits under Medicaid until a beneficiary is found ineligible under all groups covered by the state for which the beneficiary may be eligible or until the beneficiary does not timely provide requested information that is needed to make a determination.
- If the Medicaid agency determines that an individual is ineligible for Medicaid under any other basis, the state must determine potential eligibility under another insurance affordability program and transfer that individual’s electronic account.
To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at email@example.com. Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.
By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Medicaid Attorney