New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167 - PHARMACEUTICAL ASSISTANCE TO THE AGED AND DISABLED ELIGIBILITY MANUAL
Subchapter 6 - ELIGIBILITY REQUIREMENTS
Section 10:167-6.2 - Income standards

Universal Citation: NJ Admin Code 10:167-6.2

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Any single permanent resident of New Jersey who is 65 years of age or over or who is under 65 and over 18 years of age and is receiving Social Security Title II disability benefits must have an annual income of less than $ 28,769 to be eligible for PAAD.

(b) Any married permanent resident of New Jersey who is 65 years of age or over or who is under 65 and over 18 years of age and is receiving Social Security Title II disability benefits must have a combined (applicant and spouse) annual income of less than $ 35,270 to be eligible for PAAD.

1. An applicant and spouse shall be considered separate and eligibility determined under the single income standard when each maintains a separate residence and the applicant does not have access to the spouse's income.
i. Any support payment received by the applicant for the sole benefit of the applicant shall be considered as income for PAAD eligibility purposes.

2. An applicant and spouse may be considered separated when the spouse has been institutionalized in a long-term facility, either skilled or intermediate, or in a State or county psychiatric hospital at least 30 consecutive days prior to application.
i. PAAD shall consider the applicant and spouse separated only when doing so is more favorable to the applicant for PAAD (for example, when the income of an applicant and his or her institutionalized spouse is combined at $ 35,270, the applicant is ineligible for PAAD, but if the applicant and spouse are considered separated, the applicant could be eligible for PAAD under the single income standard. If the institutionalized spouse was not covered by Medicaid, the spouse could become eligible under the single income standard).

(c) All income, from whatever source derived, is considered in determining eligibility for the purpose of PAAD. Jointly owned income sources, will be allocated according to degree of ownership.

1. All income, taxable and nontaxable, is to be included. Examples of possible sources of income (gross amounts unless otherwise noted) are as follows:
i. Social Security benefits paid to or on behalf of the applicant;

ii. Veterans benefits;

iii. Disability benefits, whether public or private;

iv. Salaries;

v. Wages;

vi. Bonuses;

vii. Commissions;

viii. Fees;

ix. Dividends;

x. Interest taxable and nontaxable;

xi. Capital gains;

xii. Royalties;

xiii. Bequests and death benefits;

xiv. Support payments;

xv. Unemployment benefits;

xvi. Pensions and black lung benefits;

xvii. Annuities (contributory and non-contributory, qualified and nonqualified);

xviii. Retirement benefits including distribution from Individual Retirement Arrangements (IRAs) (Traditional, Simple, Roth, Educational) and benefit payments from foreign countries;

xix. Business income (net);

xx. Fair market value of prizes and awards.

xxi. Gambling and lottery winnings; and

xxii. Rental income (net after expenses).

2. Sources of income, which are excluded in considering eligibility for PAAD are as follows:
i. Benefit amounts received under the New Jersey State Lifeline Credit Program/Tenants Lifeline Assistance Program;

ii. Benefits received under New Jersey State Homestead Rebates;

iii. Proceeds from spouse's life insurance;

iv. Capital gains of up to $ 250,000 for a single person or up to $ 500,000 for a married couple on the sale of a main home which is also excluded from income taxation by IRS and the New Jersey Division of Taxation;

v. Stipends from the Volunteers in Service to America (VISTA), Foster Grandparents programs, Workforce 55+ program, and programs under Title V of the Older Americans Act of 1965;

vi. Agent Orange payments;

vii. Reparation payments to Japanese Americans by the Federal Government pursuant to sections 105 and 106 of the Civil Liberties Act of 1988, P.L. 100-383 (50 U.S.C. App. 1989b-4 and 1989b-5);

viii. Rewards involving health care fraud or abuse which apply to 10:49-13.4;

ix. Holocaust reparations;

x. Proceeds from viatical settlements;

xi. Proceeds received by the beneficiary of a Special Needs Trust (see 10:167-2.2 for provisions);

xii. Rollovers from one tax deferred financial instrument (pension, annuity, IRA, insurance contract or other retirement benefits) to another tax deferred financial instrument;

xiii. 1035 Tax Free Exchanges of a policy or contract handled between two insurance companies; and

xiv. An insurance policyholder's original contributions if Demutualization of the policy occurs (in that case, only the earnings on the policy would be counted);

(d) The applicant must be able to document the amounts reported upon request by the Department, and will be required to submit photocopies of his/her Federal, State and/or City income tax return and other acceptance evidence.

(e) PAAD eligibility is conferred based upon annual income for the current calendar year, which is estimated at the time of application. Previous year income information is used as a gauge and supplements estimates of current income to determine current eligibility. However, if previous year income exceeds the standard, but current year income is expected to fall within legal limits, an initial applicant may estimate current year income for the purpose of establishing PAAD eligibility.

(f) Since PAAD eligibility is based upon actual annual income, if the actual income for the current calendar year exceeds the PAAD income standard, the person will become ineligible for the entire calendar year and shall be required to repay benefits paid for all prescriptions and Lifeline benefits from January 1 through December 31 of the calendar year.

(g) Upon renewal of eligibility, all re-applicants must submit previous year income information to substantiate previous estimates. Requests by re-applicants to use anticipated income, as the basis for eligibility, when previous year income exceeds the PAAD standard, will be reviewed individually.

(h) The PAAD program shall take necessary action to recover the full amount of payments made on behalf of beneficiaries during an ineligible period, when appropriate.

(i) PAAD beneficiaries are required to notify the PAAD program immediately if their current year income exceeds the PAAD income standard.

(j) Applicants who combine their income by filing joint Federal and/or State income tax returns, must combine their income for PAAD eligibility purposes for the same time period and their eligibility determination shall be based on the joint income standard, except when (b)2 above applies.

(k) Medical or other expenses are not considered or deducted from gross income for PAAD eligibility purposes.

(l) Net losses in one income category shall not be used to offset income in another category.

(m) Beginning January 1, 1996 and annually thereafter, the income eligibility limits shall increase by the amount of the maximum Social Security benefit cost-of-living adjustment for that year for single and married persons, respectively, in accordance with 42 U.S.C. § 415(i)(2)(D), incorporated herein by reference. The Commission will provide notice of the new income limits annually by publication in the New Jersey Register.

(n) If requested, applicants shall provide all income and asset information necessary to apply for the Medicare Part D Low Income Subsidy, pursuant to 20 CFR Part 418, Subpart D, and 42 CFR Part 423, which are incorporated herein by reference, as amended and supplemented.

1. The PAAD Program shall use the information to apply on behalf of the PAAD applicant for the low income subsidy by completing the Social Security Administration SSA-1020, on-line application form at http://www.socialsecurity.gov.

2. The additional income and asset information, required for the low income subsidy application and not required by (a) through (m) above shall not be used in determining PAAD eligibility, but shall only be used to determine eligibility for the low income subsidy.

3. In addition to the income and asset information required by 10:167-6.1 through 6.9 to determine eligibility, applicants shall provide the following information necessary for the Social Security Administration to determine eligibility for the low income subsidy:
i. Bank accounts (checking, savings, and certificates of deposit);

ii. Stocks;

iii. Bonds;

iv. Savings bonds;

v. Mutual funds;

vi. Individual retirement accounts or other similar investments;

vii. Any other cash at home or held anywhere else;

viii. Life insurance policies with a total face value of $ 1,500 or more;

ix. Real estate other than your home and the property on which it is located;

x. Help that you (or your spouse, if married and living together) receive to pay for any of the following household expenses - food, mortgage, rent, heating fuel or gas, electricity, water and property taxes; and

xi. The number of relatives who live with you and your spouse and depend on you or your spouse to provide at least one-half of their financial support.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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