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N.J.A.C. 10:69-6.2 This file includes all Regulations adopted and published through the New Jersey Register, Vol. 57 No. 12, June 16, 2025 NJ - New Jersey Administrative Code > TITLE 10. HUMAN SERVICES > CHAPTER 69. AFDC-RELATED MEDICAID > SUBCHAPTER 6. COMPLAINTS, HEARINGS, AND ADMINISTRATIVE REVIEWS § 10:69-6.2 Right to fair hearing and administrative review (a) It is the right of every applicant or beneficiary adversely affected by an action by a CSSA to be afforded a fair hearing in a manner established by the rules in this subchapter and by the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. These rules have been established pursuant to Federal regulations, 45 CFR 205.10, and the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. (b) The CSSA shall promptly notify the beneficiary in writing of any agency decision affecting that client. The term "agency decision" refers to a decision made by the CSSA and includes any decision made by the CSSA. In the case of a client who cannot be located, notice shall be sent to his or her last known address. (c) Agency action which adversely affects an applicant or beneficiary includes: 1. Any action, inaction, refusal of action, or unduly delayed action with respect to program eligibility, including, but not limited to, denial or termination of benefits; and 2. When the complete processing of an application is delayed beyond 30 days, the applicant is to be notified of this fact and the reason(s) for the delay on or before the expiration of such period (see N.J.A.C. 10:69-2.14 and 2.15). (d) The written notice of adverse action shall, at a minimum, include the following: 1. The action the agency intends to take; 2. The reasons for the intended agency action; 3. The specific regulations supporting such action; 4. An explanation of the individual's right to request a fair hearing; 5. An explanation of how to request a fair hearing; 6. The time limits on requesting a hearing; 7. An explanation of the right to examine evidence; 8. An explanation of the circumstances under which continued Medicaid coverage is continued if a hearing is requested; 9. An explanation of the requirement to repay Medicaid coverage received during the period pending the hearing, if the agency action is upheld; 10. A sentence in Spanish cautioning the client that the notice relates to a change in Medicaid coverage and if he or she does not understand the notice, he or she should contact the CSSA; and 11. The name, address and phone number of the nearest legal services office where available. (e) Where an agency decision results in an adverse action, there will be no termination of the AFDC- Medicaid related coverage until at least 10 days after the mailing date of the notice, except in situations described in (f) below.