reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.3 - Total gross income limits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) AFDC-related
				Medicaid program eligibility shall not exist for any month if the total income
				of the eligible unit exceeds the amount indicated in this subsection for the
				appropriate eligible unit size. For this purpose, total income shall include
				all income of the eligible unit (without benefit of the disregards described in
				this subchapter including the income of stepparents (exception: see (a)4 below
				concerning non-needy stepparents who marry an AFDC-C related Medicaid program
				parent on or after October 1, 1992)) and alien sponsors income determined
				available to the eligible unit as described in
				N.J.A.C.
				10:69-10.43. Total income includes the earned
				income of the AFDC children except for earnings disregarded by provisions of
				N.J.A.C.
				10:69-10.15. Child support payments, except
				for the first $50.00 monthly current child support received on behalf of the
				eligible unit, whether received directly by the household or collected through
				the Child Support and Paternity (CSP) process, shall be counted in the
				determination of total income. See
				N.J.A.C.
				10:69-10.36 for companion cases.
1. The TANF grant shall not be considered as
				income for this purpose.
2. Funds
				exempted under
				N.J.A.C.
				10:69-10.15 or 10.22(b)1 through 10 and
				moneys disregarded under N.J.A.C. 10:69-4.6 shall not be considered income for
				this purpose.
3. The following
				table represents 185 percent of the State's Standard of Need set forth in
				N.J.A.C.
				10:69-10.2.
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New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.4 - Eligible unit; all related Medicaid programs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				eligible unit shall be comprised of those family members who apply for and are
				eligible to receive AFDC-related Medicaid program. It shall include one or more
				eligible children unless such child is a related Medicaid program beneficiary
				of SSI benefits.
1. The eligible unit for
				AFDC-C or -F related Medicaid program shall include any blood-related or
				adoptive brothers and/or sisters living in the same household and who are
				otherwise eligible for AFDC-C or -F related Medicaid program. This requirement
				does not apply to stepbrothers and stepsisters.
2. A stepparent of the children for whom
				AFDC-related Medicaid program is sought may be included in the eligible unit if
				the provisions of
				N.J.A.C.
				10:69-10.33 apply. If the non-needy
				stepparent marries the AFDC-C related Medicaid program beneficiary parent on or
				after October 1, 1992, and the provisions of
				N.J.A.C.
				10:69-3.7 apply, the stepparent and his or
				her natural or adoptive children, as well as the natural or adoptive AFDC-C
				related Medicaid program beneficiary parent, shall be excluded from the
				eligible unit.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.5 - Eligible unit; AFDC-C- and -F related Medicaid program

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				AFDC-C related Medicaid program shall include:
1. The natural or adoptive parent(s) of one
				or more of the eligible child(ren) unless the AFDC-C-related Medicaid program
				beneficiary parent marries on or after October 1, 1992, and is excluded from
				AFDC-related Medicaid program eligibility in accordance with the provisions of
				N.J.A.C.
				10:69-10.33;
2. The stepparent (the spouse of a natural or
				adoptive parent) of the children for whom AFDC-related Medicaid program is
				sought may be included in the eligible unit if the provisions of
				10:69-2.9 apply. If a non-needy
				stepparent marries the AFDC-C related Medicaid program beneficiary parent on or
				after October 1, 1992, and the provisions of
				10:69-2.11 apply, the stepparent,
				the stepparent's natural or adoptive children as well as the natural or
				adoptive parent of the AFDC-C related Medicaid program beneficiary children are
				excluded from the eligible unit;
3.
				An enumerated parent-person and his or her spouse, when such individuals claim
				to be financially eligible; and
4.
				When the child(ren) lives with a parent-person who is not himself or herself
				applying for AFDC-related Medicaid program and a natural or adoptive parent is
				not in the home, only the eligible child(ren) comprises the eligible
				unit.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.7 - Eligible person temporarily in an institution

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the
				eligible unit who is temporarily in an institution in accordance with
				10:69-3.29 shall continue to be
				regarded as an eligible member of that unit.
(b) When the absence of an AFDC-related
				Medicaid program parent will continue for 30 days or longer, the remaining
				members of the family may be eligible for AFDC-C-related Medicaid
				program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.8 - Eligible AFDC child or parent regularly attending school or in vocational training at a Residential Job Corps Center

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When an
				eligible child is a student regularly attending school, college or university,
				or regularly attending a course of vocational training designed to fit him or
				her for gainful employment, this child shall be included as a member of the
				eligible unit whether or not he or she is living in the home during the period
				in which he or she is pursuing his or her studies. (See
				10:69-10.9 for definitions of
				school attendance.)
(b) Any grant,
				scholarship, student loan or other financial aid received by such child shall
				be fully disregarded in determining eligibility so long as the child continues
				to attend school as stated in (a) above and meets the conditions under which
				such moneys are granted.
1. Funds received
				through college work-study programs shall be disregarded.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.9 - School attendance defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A child
				eligible under the age requirements of
				10:69-3.13 shall be considered a
				student regularly attending a school or training course when he or she is
				enrolled in and physically attending, as certified by the school or institute,
				a program of study or training leading to a certificate, diploma or degree:
1. Full time;
2. At least half-time and is regularly
				employed part-time or is available for and actively seeking part-time
				employment; or
3. At least
				half-time and is precluded from full-time attendance or part-time employment
				because of a verified physical disability.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.10 - General provisions-income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Income may be
				earned, unearned or in the form of contributions.
(b) Earned income shall not include the
				amount of Earned Income Credit payment that an individual receives.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.11 - Definition of earned income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Earned income
				refers to gross income earned by an individual through the receipt of wages,
				tips, salaries or commissions from activities in which he or she is engaged as
				an employee or from his or her self-employment. It includes earnings over a
				period of time for which settlement is made in one payment, as in the sale of
				farm crops.
(b) When an individual
				receives shelter in return for performing work duties, the monetary value shall
				be determined from Schedule VI in N.J.A.C. 10:69-10:42(c) and included in the
				total amount of gross earned income. The amount of mandatory payroll deductions
				to be recognized shall be determined in relation to such total
				amount.
(c) When an individual is
				employed in a position where tipping is customary, a daily log or other
				acceptable documentation of tips received shall be used for income calculation.
				Tips income calculation shall not be based on estimated information as reported
				on W-2 forms.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.12 - Earned income from self-employment including provisions of personal care services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) With respect to self-employment, the term
				"earned income" means the total profit from a business enterprise (such as
				farming) resulting from a comparison of the gross receipts with the business
				expenses. Business expenses are those costs directly related to producing the
				goods or services and, without which, the goods or services could not be
				produced. However, items such as depreciation, personal business and
				entertainment expenses, personal transportation, purchase of capital equipment,
				and payments on the principal of loans for capital assets or durable goods are
				not business expenses.
1. Persons who are
				self-employed shall be required to submit evidence of business receipts and
				expenditures as the basis for a sound estimate of earned income. A reliable,
				accurate accounting system or the method utilized in reporting to the Internal
				Revenue Service shall be acceptable for determining net income.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.13 - Earned income disregards for AFDC-related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CWA
				shall disregard from the earned income of each employed individual in the
				eligible family, the first $ 90.00 of such earnings to cover work-related
				expenses including, but not limited to, transportation and mandatory payroll
				deductions.
(b) The CWA shall
				disregard from the total earned income not already disregarded, an amount equal
				to the difference between 133 percent of the Federal poverty level (see 42 CFR
				9902(2) ) and the Income Standard established for the size of the family unit,
				in accordance with the chart at
				N.J.A.C.
				10:69-10.3(b)  as follows:
1. For beneficiaries eligible on and after
				June 15, 2002, regardless of date of application; and
2. For applicants who apply on and before
				June 14, 2002 with a disposition pending.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.14 - Disregard of certain allowances and payments in AFDC-related Medicaid program (all segments) for participation in JTPA

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Unearned income
				(including moneys to offset training expenses) received by an AFDC dependent
				child through the Job Training Partnership Act (JTPA) is exempt in the
				determination of initial eligibility, maximum income eligibility, and
				prospective needs test.
(b) Earned
				income received through the JTPA by an AFDC-related Medicaid program dependent
				child is exempt in the determination of initial eligibility, maximum income
				eligibility, and prospective needs test. However, the disregard of such income
				shall not exceed six months in any calendar year.
1. This disregard of income is independent of
				the earned income disregard found at
				10:69-10.8 and 10.15. If a
				full-time student secures employment unrelated to JTPA participation, another
				six-calendar-month period shall be established in accordance with the
				provisions of
				10:69-10.15(g).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.15 - Earned income disregards of a child who is a full or part-time student

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The earned
				income of any child in the eligible unit who is a full-time student, or is a
				part-time student who is not a full-time employee, shall be exempt in
				determining need of the eligible unit and in evaluating his or her capacity as
				a legally responsible relative. (See
				10:69-10.9 for definitions of full
				and part-time students.)
(b) For
				the purposes of this section, a full-time employee shall be any student whose
				average employment on a monthly basis equals 35 hours a week or more.
(c) A student who is a full or part-time
				student during the regular school term shall be considered to be a full or
				part-time student during all vacation periods.
(d) When a child claiming the exemption of
				earned income described in this section is over 16 years of age, this student
				shall be informed in writing that he or she has a responsibility for
				participating in determining his or her eligibility for such exemption. The
				student and the county board of social services have joint responsibility for
				securing the factual data from the school necessary to make the determination
				as to whether he or she is a full or part-time student, and for securing from
				his or her employer the factual data of monthly hours employed.
(e) Part-time students who are fully employed
				and are thus not eligible for the exemption of earned income as described in
				this section are eligible for the appropriate disregards depending on program
				related Medicaid program.
(f) The
				exemption of earned income of part-time students under this section does not
				apply in determining maximum income eligibility in
				10:69-10.3.
(g) The earned income of a full-time student
				shall be disregarded in the determination of maximum income eligibility
				(10:69-10.3 ) for a total of six
				months in any one calendar year.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.16 - Income from family day care

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Payments by
				individuals or agencies for children placed in an eligible family's home for
				family day care shall be considered as gross earned income from
				self-employment. Earned income procedures for self-employment are discussed at
				10:69-10.12.
1. The net income (adjusted gross earnings)
				to the eligible family is the difference between the cost of providing family
				day care and the total monthly amount paid for such care. Appropriate
				disregards apply in determining the calculated earned income (see
				10:69-10.13 ).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.17 - Division of Child Protection and Permanency payments for foster care

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Division of Child Protection and Permanency's basic monthly payments for the
				placement of children in foster care and the clothing allowance shall be
				considered as equal to the cost of providing such care and maintenance.
				However, when extra payment is received for special services, such additional
				amount shall be considered as earned income from self-employment (see
				N.J.A.C.
				10:69-10.13 ).
(b) For purposes of determining AFDC-related
				Medicaid program eligibility, such foster care children are not considered
				members of the eligible unit.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.18 - Income which is not earned

Current through Register Vol. 56, No. 14, July 15, 2024
Net income from noneligible household members (except as
				  stated in 10:69-10.12(c) 
				  ), returns from capital investment such as dividends and interest, benefits and
				  pensions, annuities, contributions from relatives, compensation payments, and
				  any other payments not considered as earned income, shall be considered as
				  unearned income. All such income shall be recognized in establishing
				  eligibility.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.19 - Income from roomer-boarders and table boarders

Current through Register Vol. 56, No. 14, July 15, 2024
Roomer-boarders or table boarders are noneligible household
				  members.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.20 - Income from apartments, rooms or housekeeping units in the eligible unit's home

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the
				eligible unit is receiving payment from rental of apartments, rooms or
				housekeeping units, the net income shall be determined by deducting the costs
				of operation and maintenance from the gross rental income received.
1. The costs of operation and maintenance are
				the greater of:
i. The actual costs of
				operation and maintenance, if known or subject to determination, or such
				reasonable allocation of actual or determined costs as may be indicated
				according to the space being rented out; or
ii. The number of rooms, excluding bathrooms,
				being rented out multiplied by the applicable monthly cost figure as follows:
(1) With no utilities: $ 23.00;
(2) Including heat only: $ 29.00;
(3) Including all utilities: $
				34.00.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.21 - Contributions of support

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Obligatory
				contributions to the support of one or more members of the eligible unit shall
				be recognized as unearned income, regardless of whether such contributions are
				in cash or in kind. (See
				10:69-10.42, Acceptable forms of
				support.)
(b) When shelter is being
				provided by a legally responsible relative (LRR) who has been determined by the
				CWA IV-A unit to have a capacity to provide support, the actual cash value
				shall, whenever possible, be determined and recognized as unearned income to
				the eligible unit. Where the actual value cannot be established, and is not
				stipulated by a court order to be made in an identifiable cash amount to a
				third party, the monthly monetary values shall be recognized according to
				Schedule VI in
				N.J.A.C.
				10:69-10.42(c)  and shall
				not exceed the LRR's evaluated capacity.
(c) Non-obligatory contributions, other than
				occasional gifts identified in
				N.J.A.C.
				10:69-10.22, shall be recognized as unearned
				income only when made in cash to one or more members of the eligible unit. This
				does not apply to LRRs who have an evaluated capacity to support.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.24 - Treatment of support income and payments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				first $ 50.00 of any child support payments received on behalf of a dependent
				child or children by any family applying for or eligible for AFDC-related
				Medicaid program shall be disregarded. Such child support payments shall
				include disregarded child support (DCS) payments paid the family through the
				child support and paternity process and direct support payments received by the
				eligible unit that represent a current monthly support obligation. These moneys
				are disregarded in determination of initial eligibility, maximum income
				eligibility, and the prospective needs test. The total amount of child support
				disregarded shall not exceed $ 50.00 per month per eligible unit.
(b) Child support and alimony paid by any
				member of the eligible unit to individuals not living in the same household
				shall be deducted from the eligible unit's income in the determination of
				eligibility for AFDC-related Medicaid program benefits.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.25 - Prospective budgeting

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective
				budgeting policy shall be applied to applicants and beneficiaries of
				AFDC-related Medicaid program benefits, including Medicaid Special.
(b) AFDC-related Medicaid program eligibility
				shall be based on a best estimate of the family's income and other
				circumstances that will exist until the next reported significant change in
				circumstance or redetermination, whichever is first. The best estimate of
				income is based on the family's and the agency's reasonable expectations and
				knowledge of current, past, and future circumstances. In determining the best
				estimate of income, the CWA shall use income projections and the concept of
				"significant and non-significant" income and circumstance changes. Verification
				of the income used shall be clearly documented in the case record.
1. For purposes of determining the family's
				eligibility, the CWA shall determine earnings by obtaining wage information for
				the four consecutive week period immediately preceding the date of application,
				redetermination, or change in circumstance based on the submission of
				documentation of income from the employer that is representative of a typical
				full pay period from each employer who provides wages to the applicant and/or
				the members of the eligible unit as defined at
				N.J.A.C.
				10:69-3.7 and 3.8. Likewise, all unearned
				income received within this four-week period is also determined. All earned and
				unearned income received within this four week period shall be verified and
				documented in the case record, even if all four weeks of income are not
				ultimately used to calculate the best estimate.
2. The receipt of income generally occurs
				weekly, biweekly, or on a semi-monthly basis. The CWA shall convert the
				reported income amount to a gross monthly amount by multiplying the reported
				income amount by the appropriate conversion factor as follows: weekly amounts
				by 4.333; biweekly amounts by 2.167; and semi-monthly amounts by two.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.26 - Eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In determining
				initial eligibility, the appropriate disregards shall be applied to earned
				income.
(b) The effective date of
				initial eligibility shall be the first day of the month of the date of the
				application if the client was eligible on the date of application. If the
				client was found eligible on any other date, initial AFDC-related Medicaid
				eligibility shall be retroactive to the first day of the month the date
				eligibility commenced.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.27 - Income from eligible and noneligible individuals in the household

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For
				purposes of AFDC-related Medicaid program, in family groups living together,
				income of the spouse is considered available for the other spouse and income of
				a parent (natural or adoptive) is considered available for children under 18.
				If the spouse or parent is living with his or her spouse or children,
				respectively, income is considered available regardless of whether the spouse
				or natural or adoptive parent is noneligible. However, if a spouse or parent is
				receiving SSI benefits, including mandatory or optional State supplementary
				payments, then for the period for which such benefits are received, his or her
				income shall not be counted as income available to the eligible
				family.
(b) A noneligible
				individual is neither sanctioned nor required by law or regulation to be
				included in the eligible unit. When a noneligible individual is living in the
				household of an eligible unit, the income from that living arrangement to the
				eligible unit shall be treated in accordance with
				N.J.A.C.
				10:69-10.3, if extensive personal services
				are provided, or
				N.J.A.C.
				10:69-10.20. If the noneligible individual is
				a non-qualified alien parent (see
				N.J.A.C.
				10:69-3.9 ), his or her income shall be
				considered available to the eligible unit and shall be calculated in accordance
				with the step-parent deeming formula in
				N.J.A.C.
				10:69-10.33.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.28 - Penalty of ineligibility for CSP sanction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An adult
				sanctioned for failure to cooperate with the child support and paternity
				requirements is not included in the eligible unit. When the adult is not
				included in the eligible unit because of this sanction and has earned or
				unearned income of his or her own, such income shall be considered available to
				the remaining members of the eligible unit.
1. For earned income, the net amount to be
				considered available to the eligible unit shall be determined without
				application of earned income disregards set forth in
				10:69-10.10 through 10.23.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.29 - Needs of certain children temporarily in the home

Current through Register Vol. 56, No. 14, July 15, 2024
When an institutionalized child is on temporary visit home
				  (and an AFDC-related Medicaid program eligible case is not in existence), he or
				  she may be eligible for General Assistance if the visit does not exceed 21
				  consecutive days. If the length of such child's visit is expected to exceed 21
				  days, the CWA shall process an AFDC-related Medicaid program application and
				  evaluate the family's eligibility for AFDC-related Medicaid program for the
				  duration of the visit.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.30 - Initial eligibility and application of disregards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) On all
				new applications, reapplications, or reopened applications, initial financial
				eligibility must be established before an HBID Card can be issued.
1. For AFDC-C- and F-related Medicaid cases,
				when the eligible family received AFDC-related Medicaid program assistance in
				one of the four months prior to the month of application, all earned income
				disregards at
				N.J.A.C.
				10:69-10.13 shall apply to the determination
				of initial eligibility. For AFDC-C- and AFDC-F-related Medicaid cases that have
				not received AFDC-related Medicaid benefits in one of the four months prior to
				the month of application, the earned income disregards apply, except that the
				disregard of the first $ 30.00 of the remaining income plus one-third of the
				remainder does not apply. If total income equals or exceeds the income standard
				in this subchapter for the eligible family size, the family is ineligible for
				Medicaid. In the computation of initial Medicaid eligibility, application of
				the $ 30.00 and one-third earned income disregards is subject to the
				limitations at
				N.J.A.C.
				10:69-10.13.
2. The earned income of a full-time student
				shall be disregarded in determining initial Medicaid eligibility to the same
				extent as provided in
				10:69-10.15. The income of a
				part-time student is not disregarded in determining initial
				eligibility.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.31 - Procedures for determining initial eligibility for AFDC-C and -F related Medicaid

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The procedures
				regarding initial income eligibility are:
1.
				Identify the number of persons in the eligible unit; and
2. Determine the total monthly income
				(including gross earned income) available to the eligible unit and compare it
				to the maximum income level in
				10:69-10.3 (Exception: For a
				non-needy stepparent who marries an AFDC-C related Medicaid beneficiary parent
				on or after October 1, 1992, eligibility for the children shall be determined
				in accordance with the regulations at
				10:69-10.33 or 10.34 as
				applicable.) If total income equals or is less than the maximum for the
				appropriate eligible unit size, maximum income eligibility has been
				established. If total income exceeds the appropriate maximum for any month, the
				family is not eligible for AFDC-related Medicaid program.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.33 - AFDC-C procedures for stepparents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When a
				stepparent of eligible AFDC-C-related Medicaid program children is in fact a
				member of the household and has married the natural or adoptive beneficiary
				parent, the natural or adoptive parent who is applying for or receiving
				AFDC-related Medicaid program shall be afforded the following elective options:
1. The stepparent may be included as a member
				of the eligible unit, with all needs recognized and his or her income
				considered in determining AFDC-related Medicaid eligibility.
2. The stepparent may not be included in the
				eligible unit, in which case the income of the stepparent shall be treated in
				accordance with (d) below.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.35 - Procedures for AFDC-C and -F related Medicaid eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A child not
				meeting AFDC-related Medicaid age requirements but who is under age 21, may be
				eligible for Medicaid Special if he or she would be otherwise eligible for
				AFDC-C or -F except for age (see N.J.A.C. 10:69-4 ).
(b) Medicaid eligibility does not exist in
				cases where, after excluding the child(ren) whose income caused ineligibility
				for AFDC-related Medicaid, there is no child remaining in the eligible
				family.
(c) Any family whose
				eligibility is denied or terminated as a result of deeming of a sibling's or
				stepparent's income shall have its AFDC-related Medicaid eligibility evaluated
				without regard to that individual's needs or income.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.36 - Companion cases

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An eligible
				unit may include some members eligible for AFDC-C-related Medicaid and others
				eligible for AFDC-F-related Medicaid. These combinations are called companion
				cases.
(b) Companion cases shall
				have a common case number.
(c) The
				AFDC-related Medicaid eligibility income standard for each related Medicaid
				program shall be the income eligibility standard for the total eligible unit at
				10:69-10.4, as
				appropriate.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.37 - Calculation of contract earning income

Current through Register Vol. 56, No. 14, July 15, 2024
Earnings payable under the terms of a renewable contract,
				  for example, earnings of school teachers, are to be prorated over the stated
				  term of the contract only.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.38 - Calculation of earnings as lump sum payment

Current through Register Vol. 56, No. 14, July 15, 2024
When a member of the eligible unit receives a lump sum
				  payment for services rendered over a period of more than a month, any disregard
				  of earned income is to be computed for each month in which such income was
				  earned.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.39 - Calculation of contributions of legally responsible relatives

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The CWA
				shall determine what contribution, whether in cash or kind, the relative is
				currently contributing or is willing to contribute toward the support of the
				eligibility unit.
1. Only the amount of
				support, whether in cash or in kind, actually being received by the eligible
				unit shall be considered as available income.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.40 - Evaluating LRR's capacity to support

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The LRR's
				capacity to support shall be based on his or her total gross monthly income,
				including all income of whatever kind and from whatever source except as stated
				in this section.
(b) Income
				determination rules are as follows:
1. "Gross
				income" means income before deductions, or the net profit from a business, farm
				or profession before income and other personal taxes are deducted. "Net profit"
				is the total revenue less the cost of producing the revenue. Business
				deductions which are allowable for income tax purposes may be recognized as
				expenses of producing this revenue.
2. The average income for the most recent
				period of four months may be accepted as satisfactory evidence of the average
				for the last year, but the income record for the entire 12-month period may be
				considered if the individual so requests and makes the necessary information
				available.
3. When an LRR is
				receiving food or lodging or both as part of his or her income, the total gross
				income shall be determined as follows:
i. The
				gross cash payment plus the monetary value of the maintenance received as used
				by the employer for tax purposes (the employer's monetary evaluation for
				payment of Social Security and withholding taxes).
4. When an LRR has roomer-boarders living in
				the home, 10:69-10.12(c) 
				or 10.20 shall be used to determine the net income to the LRR from such roomers
				or roomer-boarders.
5. When an LRR,
				other than a natural or adoptive parent, is living in the home of an eligible
				unit and makes payment to the eligible unit toward household expenses, that
				payment shall be treated as income available to the eligible unit in accordance
				with 10:69-10.12(c),
				if extensive personal services are provided, or N.J.A.C. 10:69-4.12. Such
				payment does not otherwise affect the LRR's evaluated capacity, if any, to
				contribute to support.
6. When an
				LRR has an emancipated child living in the home, such child shall be considered
				as a roomer or roomer-boarder.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.41 - Determining amount of LRR support

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Two sets of
				standards provide the basis for evaluation of an LRR's capacity to contribute
				to the support of the eligible unit:
1.
				Schedule IV-Part A applies to any natural or adoptive parent of eligible
				AFDC-related Medicaid children who is not a member of the eligible unit
				(exception: when a stepparent is providing a parent's needs). The monthly
				income standard is derived from the applicable income eligibility standard plus
				average medical costs and the standard allowance for expenses of
				employment.
2. Schedule IV-Part B
				applies to all other legally responsible relatives, including parents of
				adolescent parents not living in the same home as the adolescent parent, and is
				based on the U.S. Bureau of Labor Statistics' moderate standard of
				living.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.42 - Acceptable forms of LRR support

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The LRR may
				fulfill his or her obligation to support the person or persons for whom he or
				she is responsible by contributing one or more of the following:
1. Cash;
2. Shelter and household needs;
				and/or
3. Any other item determined
				to be mutually satisfactory to the client and CWA for which equitable monetary
				value can be clearly established.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.43 - Eligibility of sponsored aliens and deeming of sponsor's income to a sponsored alien

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The income of an alien's sponsor shall be
				deemed to be unearned income of an alien applying for AFDC-related Medicaid.
				Deeming continues until the earlier of naturalization of the immigrant or the
				immigrant's being credited with 40 quarters of Social Security coverage. Such
				quarters do not include any quarters after December 31, 1996 in which the
				immigrant or the immigrant's spouse/parent on whose record the immigrant is
				credited with quarters receives Federal means tested benefits. For purposes of
				this section, a sponsor is an individual, a public or private agency or
				organization who executed a legally binding affidavit of support on behalf of
				an alien (who is not the child of the sponsor or the sponsor's spouse) as a
				condition of the alien's entry into the United States. No income shall be
				deemed from a sponsor who is (or whose spouse is) receiving AFDC-related
				Medicaid or SSI.
1. These deeming provisions
				do not apply to any alien who is:
i. Admitted
				as a conditional entrant refugee to the United States as a result of the
				application of the provision of section 203(a)(7) (in effect prior to April 1,
				1980) of the Immigration and Nationality Act;
ii. Admitted as a refugee to the United
				States as a result of the application of the provisions of section 207(c) (in
				effect after March 31, 1980) of the Immigration and Nationality Act;
iii. Paroled into the United States as a
				refugee under section 212(d)(5) of the Immigration and Nationality
				Act;
iv. Granted political asylum
				by the Attorney General under section 208 of the Immigration and Nationality
				Act;
v. A Cuban or Haitian entrant
				as defined in section 501(e) of the Refugee Education Assistance Act of 1980 (
				Public Law 96-422 );
vi. An
				Amerasian admitted under Section 584 of the Foreign Operation Appropriations
				Act beginning March 20, 1988; or
vii. Battered immigrants or those who would
				be indigent, defined as unable to obtain food or shelter without assistance,
				because their sponsors are not providing adequate support.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 10 - INCOME › Section 10:69-10.44 - Deeming income of parents of adolescent parents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the
				Tax Reform Act of 1986 ( P.L. 99-514 ), which clarifies certain amendments of
				the Deficit Reduction Act of 1984 ( P.L. 98-369 ), an adolescent parent is an
				individual under the age of 18 and who is himself or herself a parent of a
				dependent child.
(b) When an
				adolescent parent lives in the same home as his or her own parent(s), the
				income of such parent(s) shall be considered available to the eligible family
				in accordance with the following procedures. These rules do not apply if the
				parent(s) receive(s) SSI or AFDC-related Medicaid.
1. The gross earned income (and net income
				from self-employment) of each employed parent shall be reduced by $
				90.00.
2. The result shall be added
				to the unearned income of the parent(s).
3. The remaining income shall be further
				reduced by the appropriate amount from the standard of need (10:69-10.2 ) for the parent(s) and
				any other individuals residing in the household who are or could be claimed by
				the parent(s) as dependents for Federal personal income tax liability and who
				are not beneficiaries of TANF or AFDC-C or-F-related Medicaid.
4. The remaining income shall be further
				reduced by amounts paid by the parent(s) to individuals not living in the
				household who are or could be claimed by him or her as dependents for purposes
				of determining his or her Federal personal income tax liability.
5. Any income remaining shall be reduced by
				any amounts paid by the parent(s) as alimony or child support to individuals
				not living in the household.
6. All
				income remaining shall be counted as unearned income available to the eligible
				unit and shall be counted toward total income (10:69-10.3 ) and in the
				determination of eligibility.
i. In the event
				the eligible family unit is determined financially ineligible for AFDC-related
				Medicaid program due to the inclusion of such deemed income, Medicaid
				eligibility for the dependent child(ren) of the adolescent parent shall be
				determined in accordance with (c) below.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 11 - RESOURCES › Section 10:69-11.1 - Resources and eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Individuals
				seeking benefits under the provisions of this chapter shall be determined
				eligible or ineligible without regard to the value of the household unit's
				resources. The eligibility determination agency shall inquire about the
				household unit's resources only in order to establish income that may result
				from the household unit's resources.
1. For
				the purposes of this section, resources shall include, but not be limited to,
				stocks, bonds, certificates of deposit, savings accounts and checking accounts.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN › Section 10:69-12.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter describes presumptive eligibility for
				  children up to the age of 19 who otherwise meet the eligibility requirements
				  for AFDC-related Medicaid or Medicaid Special. The presumptive eligibility
				  determination makes it possible for a child or the children to be covered by
				  AFDC-related Medicaid or Medicaid Special services from a Medicaid provider for
				  a temporary period prior to application for AFDC-related Medicaid or Medicaid
				  Special benefits and while an application for these benefits is being processed
				  by the CWA.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN › Section 10:69-12.2 - Period of presumptive eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The period of
				presumptive eligibility shall begin on the date an approved presumptive
				eligibility entity determines that, based on information provided by the family
				or representative of the presumptive eligibility beneficiary, the child(ren)
				meet(s) the requirements and standards of this subchapter.
(b) The period of presumptive eligibility
				shall terminate:
1. On the date a
				determination of eligibility or ineligibility for AFDC-related Medicaid or
				Medicaid Special is made; or
2. If
				the child, if appropriate, the child's parent, guardian, caretaker relative, or
				sponsoring adult fails to file an application with the CWA, on the last day of
				the month subsequent to the month in which the child(ren) was determined
				presumptively eligible.
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN › Section 10:69-12.3 - Requirements for presumptive eligibility determination entities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A qualified
				presumptive eligibility entity shall be a New Jersey Medicaid provider and:
1. An acute care hospital;
2. A local health department; or
3. A Federally Qualified Health Center
				(FQHC).
New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 69 - AFDC-RELATED MEDICAID › Subchapter 12 - PRESUMPTIVE ELIGIBILITY FOR AFDC-RELATED MEDICAID CHILDREN › Section 10:69-12.4 - Presumptive eligibility processing performed by the presumptive eligibility determination entity

Current through Register Vol. 56, No. 14, July 15, 2024
(a) From preliminary information provided by
				the child, if appropriate, a parent, guardian, caretaker relative, or
				sponsoring adult, the qualified presumptive eligibility entity shall determine
				if the child meets the eligibility criteria of this subchapter. The qualified
				presumptive eligibility entity shall obtain sufficient information from the
				child, if appropriate, parent, guardian, caretaker relative, or sponsoring
				adult by having the child, if appropriate, parent, guardian, caretaker
				relative, or sponsoring adult to complete the one-page presumptive eligibility
				(PE) application. For purposes of the presumptive eligibility determination,
				the approved presumptive eligibility entity shall request from the child, if
				appropriate, parent, guardian, caretaker relative, or sponsoring adult only
				that information necessary to determine the child's presumptive eligibility or
				ineligibility. The approved presumptive eligibility determination entity shall
				make the determination of eligibility based solely on information obtained in
				the interview and shall not require any verification or documentation of the
				presumptive eligibility applicant's statements.
(b) For any child determined presumptively
				eligible, the approved presumptive eligibility determination entity shall:
1. Complete and sign the one-page presumptive
				eligibility (PE) application and forward the original of the application to the
				Division of Medical Assistance and Health Services within two working days of
				the date the presumptive eligibility determination was made;
2. Forward a copy of the completed
				application and a referral, if appropriate, to the CWA of the child's county of
				residence;
3. Inform the child, if
				appropriate, parent, guardian, caretaker relative, or sponsoring adult that
				they must contact the CWA in order to set up an appointment to complete the
				application process for AFDC-related Medicaid or Medicaid Special
				benefits;
4. Give the child, if the
				child has completed the application for presumptive eligibility, parent,
				guardian, caretaker relative, or sponsoring adult of the presumptively eligible
				child a copy of both the application and any referral; and
5. Advise the child, if the child has
				completed the application for presumptive eligibility, parent, guardian,
				caretaker relative, or sponsoring adult of the presumptively eligible child, in
				writing, of the address and telephone number of the appropriate CWA.