New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 71 - MEDICAID ONLY › Subchapter 5 - INCOME › Section 10:71-5.4 - Includable income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any income which is not specifically
				excluded under the provisions of
				10:71-5.3 shall be includable in
				the determination of countable income. Such income shall include, but is not
				limited to, the following:
1. Wages,
				salaries, tips, and commissions: Any and all compensation for services
				performed as an employee shall be included as earned income.
2. Income from self-employment: Net adjusted
				income from self-employment shall be included as earned income.
i. Determination of net adjusted income from
				self-employment: In the determination of net adjusted income, IRS rules shall
				apply.
(1) Individual business: Net adjusted
				income shall be the amount of gross income, less all allowable deductions
				attributable to the trade or business.
(2) Partnership: Net adjusted income shall be
				the individual's distributive share of the trade or business in which he/she is
				a partner.
ii.
				Annualization of income: If income from self-employment is received on other
				than a monthly basis, such income shall be averaged over the most recently
				ended taxable year in order to determine the average monthly or quarterly
				income to the individual, with the following exceptions:
(1) Seasonal self-employment: An individual
				whose income from seasonal self-employment is supplemented by income from
				employment and/or other sources during the balance of the year shall not have
				his/her self-employment income annualized. Income from self-employment shall be
				averaged only over the period in which it is intended to cover.
3. Annuities, pensions,
				and other benefits: Payments received in an annuity, pension, retirement or
				disability benefits, workers or unemployment compensation, veteran's Social
				Security (gross income), or strike benefits shall be included as unearned
				income.
i. Social security income: SSA gross
				income shall be defined as the actual amount of the check, plus any premium
				deduction made under the Supplemental Medical Insurance Program (SMI on Part B
				Medicare).
4.
				Educational grants and loans: Scholarships, educational grants, fellowships,
				and veteran's educational benefits shall be included as unearned income, except
				as provided in
				10:71-5.3(a)10.
5. Support, alimony, and inheritances:
				Support, alimony, and inheritances, in the amounts actually received, shall be
				included as unearned income except as provided in
				10:71-5.3(a)14.
6. Vendor payments: Cash payments, except
				those for medical costs, which are made on behalf of the individual by an
				organization or other third party shall be included as unearned
				income.
7. Proceeds of life
				insurance policies: Payments made as the result of the settlement of a life
				insurance policy claim shall be included as unearned income except as provided
				in 10:71-5.3(a)8.
8. Prizes, gifts, and awards: Cash or in-kind
				payments which are received as prizes, gifts, or awards shall be included as
				unearned income. (Occasional gifts, such as Christmas presents, with a value of
				$ 20.00 or less, are excluded.)
i. Gift
				defined: A gift shall be defined as any payment which is neither given as
				compensation for services or other consideration, nor as satisfaction of any
				legal obligation to the beneficiary of the gift.
ii. Value of in-kind prizes, gifts, or
				awards: The value of an in-kind prize, gift, or award shall be its cash
				value.
9. Dividends,
				interest royalties: Dividends, interest, and royalties shall be included as
				unearned income.
10. Rental income
				and income from roomer-boarder: The amount remaining, after all the costs
				(except depreciation costs) of producing the income have been deducted, shall
				be included as unearned income.
11.
				Lump-sum payments: A lump-sum payment shall be included as income (either
				earned or unearned, as appropriate) either in the month in which it is received
				or prorated over three months when the payment exceeds the individual's monthly
				deficit, except as follows:
i. No portion of
				a cash reward provided to any individual by the Division for providing
				information about fraud and/or abuse in any program administered in whole or in
				part by the Division shall be included in the computation of income for
				financial eligibility purposes.
12. Support and maintenance furnished in-kind
				(community cases): Support and maintenance encompasses the provision to an
				individual of his or her needs for food, clothing, and shelter at no cost or
				reduced value. Persons determined to be "living in the household of another" in
				accordance with
				10:71-5.6 shall not be considered
				to be receiving in-kind support and maintenance as the income eligibility
				levels have been reduced in recognition of such receipt. Persons not determined
				to be "living in the household of another" who receive in-kind support and
				maintenance shall be considered to have income in the amount of:
$ 260.33 for an individual
$ 380.67 for a couple
i. In the event the individual/couple can
				demonstrate that the actual value of in-kind support and maintenance is less
				than the assigned value, the lesser value shall be counted as unearned
				income.
ii. The income levels in
				(a)12 above shall be revised annually to reflect the annual cost-of-living
				adjustment to the SSI payment standard made by the Social Security
				Administration in accordance with
				42 U.S.C. §
												1382f. The income level revisions to (a)12
				above will be published annually as a notice of administrative change in the
				New Jersey Register.
13.
				Support and maintenance furnished in-kind (other living situations):
i. Title XIX facilities: In-kind support and
				maintenance is not counted in cases in which the individual is considered
				institutionalized for program purposes (i.e., the individual's eligibility is
				determined under the Medicaid "Cap").
ii. Private nonprofit domiciliary care
				facility: The value of in-kind support and maintenance provided an individual
				in a nonprofit residential care facility is excluded when all the following
				conditions are met:
(1) The facility is not a
				public facility. A public facility is one which is the responsibility of a
				governmental unit or over which a governmental unit exercises administrative
				control.
(2) The facility, or the
				distinct portion in which the individual resides, is neither a Title XIX
				in-kind nor an institution for educational or vocational training.
(3) The facility is tax-exempt under Section
				501(c) or (d) of the Internal Revenue Code.
(4) The facility (or organization controlling
				it) provides support and maintenance to the individual but does not receive
				payment for that part to be excluded or receives such payment from a private
				nonprofit organization which is also tax exempt under Section 501(c) or (d) of
				the Internal Revenue Code.
(5) The
				nonprofit facility or nonprofit organization has not undertaken an express
				obligation to furnish full support and maintenance to the individual. An
				express obligation to provide full support and maintenance exists when an
				institution agrees to provide lifetime care in return for a specified lump sum
				payment and there is no requirement for any current or future payment. An
				express obligation also exists if, as a result of the membership of the
				individual or of a relative, in an organization (fraternal or religious order,
				union, etc.) there exists a written document requiring the facility to provide
				lifetime care regardless of payment provided.
(6) If the criteria in (a)13ii(1)-(5) above
				are not met, the value of support and maintenance is determined in accordance
				with (a)13iii below.
iii. Other nonmedical facilities:
(1) Facility is proprietary (private
				for-profit) or private non-profit and no third party pays: The value of in-kind
				support and maintenance is excluded from income if it is provided by such a
				facility, no third party payment is made for it, and:
(A) The individual makes some payment which
				the facility accepts as payment in full (even though its usual charge may be
				higher); or
(B) The individual
				contracts a written indebtedness to the facility for his/her support and
				maintenance and the facility accepts the amount of the debt plus the
				individual's payment, if any, as payment in full.
(2) Facility if proprietary or private
				nonprofit and third party pays: When a proprietary (private for-profit) or
				private nonprofit facility provides support and maintenance to an individual
				because a third party pays the facility on that individual's behalf, that
				individual is receiving in-kind support and maintenance. The value of the
				in-kind support and maintenance is determined in accordance with (a)12
				above.
(3) Other situations
				regardless of third-party payment: In other types of facilities, support and
				maintenance provided by that facility is unearned income to the individual in
				accordance with (a)12 above.