Current through Register Vol. 56, No. 18, September 16, 2024
(a) The term
"budget unit" means those persons whose income and resources are counted in the
determination of eligibility for persons applying for or eligible for the
Medically Needy Program. Incurred medical expenses of all members of the budget
unit are applied in meeting spend-down liability when applicable (see N.J.A.C.
10:70-6). Only those members of the budget unit who are either SSI-related or
AFDC-related (see
10:70-3.4) may qualify for
coverage under the Medically Needy Program.
(b) For AFDC-related persons (pregnant women
and children under the age of 21), the budget unit shall be constituted as
follows:
1. A pregnant woman shall comprise a
budget unit of two (except in medically verified cases of multiple pregnancy,
where the budget unit shall consist of the pregnant woman and the confirmed
number of fetuses). If the pregnant woman is married and living with her
husband, the budget unit shall consist of one additional person. The woman's
natural or adoptive children under the age of 21, living in the same household,
shall be included in the budget unit. If the pregnant woman is under the age of
21 and resides in the same household as her natural or adoptive parents, the
parents shall be included in the budget unit.
2. For children under the age of 21, the
budget unit shall be composed of all blood-related or adoptive brothers and
sisters under the age of 21 living in the same household, as well as the
natural or adoptive parent(s) of the children when living in the same
household.
i. In the event the children under
the age of 21 reside with a stepparent, the stepparent may be included in the
budget unit. If the stepparent is included in the budget unit, his or her
income and resources will be included in the determination of Medically Needy
eligibility and his or her medical expenses will apply in the determination of
spend-down liability, if applicable. If the stepparent is not to be included in
the budget unit, his or her income, resources, and medical expenses will not be
included in the determination of Medically Needy eligibility.
ii. The option of including or not including
the stepparent in the budget unit, and the consequences thereof, shall be fully
explained to program applicants so that an informed decision may be
made.
3. Any person who
is in receipt of AFDC or SSI or who has applied for and been found eligible for
regular Medicaid benefits related to those programs shall not be included in
the budget unit of an AFDC-related case. Any person whose income and resources
have been deemed to an eligible SSI beneficiary shall likewise not be included
in the budget unit.
(c)
For SSI-related persons (aged, blind, and disabled individuals), the budget
unit shall be constituted as follows:
1. An
aged, blind, or disabled adult not living with his or her spouse is a budget
unit of one regardless of the number of other persons (related or unrelated)
living in the same household.
2. An
aged, blind, or disabled adult living with his or her spouse (whether or not
the spouse is program eligible) is a budget unit of two regardless of other
persons (related or unrelated) living in the same household (see
10:70-4.6(d)1
for an exception to this rule in circumstances involving an SSI-related
child).
3. For a blind or disabled
child (under the age of 21), the budget unit shall consist of the child.
Parental income is deemed to any such child under the age of 18 in accordance
with provisions at
10:70-4.6(d).
4. For circumstances in which more than one
sibling residing in the same household with their parent(s) apply as
SSI-related, each such child will be a budget unit of one person and parental
income deemed in accordance with provisions at
10:70-4.6(d).
5. Any person who is in receipt of AFDC or
SSI or who has applied for and been found eligible for regular Medicaid
benefits related to those programs shall not be included in the budget unit of
an SSI-related case.
6. When one or
more siblings of a Medically Needy SSI-related child apply for and are found
eligible for the Medically Needy Program as AFDC-related, the SSI-related child
will be considered in a budget unit of one. (Parental income and resources will
be considered toward the AFDC-related children only.)
(d) In family groups living in the same
household, some of the members may qualify as SSI-related and others as
AFDC-related. The family's choice of persons for whom Medically Needy benefits
are sought will vary the composition of the budget unit and affect eligibility
for the program. Available options shall be fully explained to the family by
the county board of social services so that the family may make an informed
decision regarding application options.
