New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.6 - Income eligibility standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Table B which
				follows shall be used to determine income eligibility for aged, blind, and
				disabled persons who make application for Medicaid Only benefits. The standard
				used for applicants/beneficiaries shall be determined in accordance with the
				following living arrangement categories. (For cases involving the deeming of
				income, this section shall be used in conjunction with
				10:71-5.5 ). The income
				eligibility standards in Table B which follows will be revised annually to
				reflect the annual cost-of-living adjustments to the SSI payment standards made
				by the Social Security Administration in accordance with
				42 U.S.C. §
										1382f. A notice of administrative changes
				containing the revisions will be published annually in the New Jersey
				Register.
(b) The income standard
				for Residential Health Care Facilities (RHCFs) (Table B, Figure I) shall be
				used for individuals/couples residing in such facilities which are licensed by
				the New Jersey Department of Health and Senior Services. Individuals in
				unlicensed facilities shall always be categorized as "living alone"
				(10:71-5.6(c)  and
				Table B, II).
(c) The following
				provisions apply to non-institutional living arrangements:
1. The category "living alone" (Table B,
				Figure II) shall be used for individuals/couples who are:
i. Living physically alone;
ii. Living in a commercial establishment,
				such as a motel, hotel, rooming or boarding house (including type A, B and C,
				formerly known as unlicensed boarding homes) that holds itself open to the
				public as such;
iii. Living in a
				business-like arrangement;
iv.
				Purchasing or preparing food separately, which applies to persons living with
				others in a private dwelling, but separately purchasing or preparing their own
				food. The determination is based on the person's customary food purchase and
				preparation habits. Occasional joint purchase or preparation of food does not
				preclude a person from this classification;
v. Taking of all meals elsewhere, which
				applies to persons living with others in a private dwelling but taking all
				meals elsewhere; or
vi. Persons
				living as members of a household but having ownership or rental responsibility
				and paying more than their pro rata share of the household expenses (because
				other members are paying less) are considered to be living alone.
(1) It is assumed that a couple share rental
				or ownership responsibility. Therefore, the following steps are necessary to
				determine if the eligible individual with ineligible spouse and other household
				members is paying more than his or her pro rata share of household expenses.
(A) If the eligible individual's
				contributions (singly) are more than his or her pro rata share of household
				expenses, he or she will be considered living alone. If not, proceed to
				(c)1vi(1)(B) below.
(B) If the
				contributions of both the eligible individual and ineligible spouse to the
				household are more than their pro rata share, they shall be considered to be
				living alone. If their contribution is equal to or less than their pro rata
				share, the applicants/beneficiaries shall be considered to be living with
				others (see
				10:71-5.6(c)3 
				).
(C) Household expenses are
				limited to: food; mortgage or rental payments; real property taxes; heating
				fuel; gas; electricity; water; sewer; and garbage removal.