Opinion ID: 5127102
Heading Depth: 2
Heading Rank: 3

Heading: The Challenged Regulation

Text: We turn now to the chapter of the New Jersey Administrative Code containing the regulation pertaining to ABD beneficiaries that is challenged in this appeal. Corresponding in part to, and indeed promulgated as an emergency regulation following the enactment of N.J.S.A. 30:4D-3(i)(11), see 20 N.J.R. 548(a), 1103(a), are DMAHS’s regulations for the ABD program. N.J.A.C. 10:72 (titled “New Jersey Care . . . Special Medicaid Programs Manual”). This chapter of regulations contains “the criteria for Medicaid eligibility for . . . certain aged, blind and disabled persons not eligible under the provisions of N.J.A.C. 10:71 [Medicaid Only].” N.J.A.C. 10:72-1.1 (emphasis added). Like the Medicaid Only program, the ABD program sets a level of income eligibility and provides a process for income deeming. The applicants challenged a subsection within the income deeming process and how it affects eligibility. The Regulation states: (a) Except as specified below, countable income for aged, blind, and disabled individuals shall be determined in accordance with rules applicable to income in Medicaid Only--Aged, Blind, and Disabled (see N.J.A.C. 10:71-5). .... (d) In accordance with the rules at N.J.A.C. 10:71-5.5, the income of the spouse of an aged, blind, or disabled 17 individual shall be deemed to the aged, blind, or disabled individual if they are residing in the same household. Income of the parent(s) of a blind or disabled child under the age of 18 residing in the same household shall be deemed available to the child in determining income eligibility for benefits under this chapter. No income shall be deemed to an aged, blind, or disabled individual from a person who is a member of a household unit of an eligible pregnant woman or child under the provisions of this chapter or who is in the budget unit of eligible AFDC-related Medically Needy cases (including a case that is eligible pending spend-down).
deeming) of the aged, blind, or disabled individual exceeds the poverty income guideline for one person he or she is ineligible for benefits and income deeming does not apply.
aged, blind, or disabled individual, the total countable income after deeming is compared to the poverty income guideline for two persons.
the child’s income after deeming is compared to the poverty income guideline for one person.
to both an aged, blind, or disabled individual and a blind or disabled child, the income is first deemed to the aged, blind, or disabled spouse. If the income (after deeming) of the aged, blind, or disabled spouse does not exceed the poverty income guideline, he or she is income eligible and there is no income to be deemed to the blind or disabled child. If the poverty income guideline is exceeded, the aged, blind, or disabled 18 adult is income ineligible and the excess income is deemed to the blind or disabled child.
more than one blind or disabled child, the deemable income shall be divided equally among such children. [N.J.A.C. 10:72-4.4(a) and (d) (emphasis added).]