Current through Register Vol. 56, No. 18, September 16, 2024
(a) The
resources criteria and eligibility standards of this section apply to all
applicants and beneficiaries.
(b)
Resources defined: For the purpose of this program a resource shall be defined
as any real or personal property which is owned by the applicant (or by those
persons whose resources are deemed available to him or her, as described in
10:71-4.6) and which could be
converted to cash to be used for his or her support and maintenance. Both
liquid and nonliquid resources shall be considered in the determination of
eligibility, unless such resources are specifically excluded under the
provisions of
10:71-4.4(b).
(c) Availability of resources: In order to be
considered in the determination of eligibility, a resource must be "available."
A resource shall be considered available to an individual when:
1. The person has the right, authority or
power to liquidate real or personal property or his or her share of
it;
2. Resources have been deemed
available to the applicant (see
10:71-4.6 regarding deeming of
resources); or
3. Resources arising
from a third-party claim or action are considered available from the date of
receipt by the applicant/beneficiaries, his or her legal representative or
other individual acting on his or her legal behalf in accordance with the
following definition and provisions.
i.
Definition of "availability of resources in third-party situations": In
third-party situations in which applicants/beneficiaries have brought an action
or made a claim against a third party who is or may be liable for payment of
medical expenses related to the cause of the action or claim, funds are
considered available or countable at the moment of receipt by the
applicant/beneficiary, his or her legal representative, guardian, relative or
any person acting on the applicant's/beneficiary's behalf. Such funds should be
considered available or countable at the earliest date of receipt by any of the
aforementioned entities.
(1) In determining
resource eligibility in accordance with
10:71-4.5(a),
those funds actually available to the applicant/beneficiary or any person
acting on his or her behalf as of the first day of the month subsequent to the
month of receipt shall be considered a countable resource, unless otherwise
excluded (see
10:71-4.4) .
(2) If a bona fide lien or judgment exists
against such funds, making all or some portion of the funds inaccessible to the
applicant/beneficiary, CWAs shall deduct the encumbrances and consider the
remaining amount as a countable resource.
(3) If between the date of receipt of such
moneys and the first day of the subsequent month the applicant/beneficiary pays
outstanding medical expenses and/or other expenses, the CWA shall consider only
the funds remaining after such payment as a countable resource.
(d)
Evaluation of resources: The value of a resource shall be defined as the price
that the resource can reasonably be expected to sell for on the open market in
the particular geographic area minus any encumbrances (that is, its equity
value).
1. Real property:
i. Sole ownership: When the eligible
individual is sole owner and has the right to dispose of the property, the
total equity value (see (d)1iv below) shall be counted toward the resource
maximum.
ii. Joint ownership or
ownership in common: Under joint ownership or ownership in common, the equity
value of the property shall be divided by the number of owners and the eligible
individual's share counted toward the resource maximum.
iii. Ownership by the entirety: Ownership by
the entirety (or tenancy by the entirety) refers to property owned by a husband
and wife whereby each member has ownership interest in the whole property which
is indivisible. When a married couple (either one or both are eligible) is
living together, the total equity value of all nonexempt property shall be
counted toward the resource maximum. The same policy shall apply to an eligible
couple who have been separated less than six months. If the eligible couple has
been separated for six months or more, one half of the value represents a
resource to each individual. If one spouse is institutionalized and the other
spouse resides in the community, the extent to which either spouse has
ownership of the property shall be included pursuant to
10:71-4.8.
(1) When an eligible individual and an
ineligible spouse own nonexempt property by the entirety and the couple is
separated for a full calendar month, the cooperation of both owners is
necessary to ascertain resource value. If the ineligible owner expresses
willingness to dispose of the property, then its value is divided by the number
of owners. If there is no such willingness by the ineligible owner, then no
value may be assigned to the property. (See also
10:71-4.4(b)6
regarding situations in which a co-owner refuses to liquidate.)
iv. Equity value: The equity value
of real property is the tax assessed value of the property multiplied by the
reciprocal of the assessment ratio as recorded in the most recently issued
State Table of Equalized Valuations, less encumbrance, if any. The Table is
available from the State of New Jersey, Department of the Treasury, Trenton,
New Jersey 08625.
v. Substantial
equity value: Individuals seeking benefits with respect to nursing facility
services or other long-term care services who have an equity interest in their
home that exceeds $ 750,000 (as indexed) shall not be eligible for benefits.
(1) Effective January 1, 2011, the home
equity limits shall be indexed to the Consumer Price Index - Urban (CPIU)
annually and rounded to the nearest thousand. The annual adjustment shall be
published as a notice of administrative change in the New Jersey Register. As
of January 1, 2011 the excess home equity limit is $ 758,000.
2. Savings and checking
accounts: When a savings or checking account is held by the eligible individual
with other parties, all funds in the account are resources to the individual,
so long as he or she has unrestricted access to the funds (that is, an "or"
account) regardless of their source. When the individual's access to the
account is restricted (that is, an "and" account), the CWA shall consider a pro
rata share of the account toward the appropriate resource maximum, unless the
client and the other owner demonstrate that actual ownership of the funds is in
a different proportion. If it can be demonstrated that the funds are totally
inaccessible to the client, such funds shall not be counted toward the resource
maximum. Any question concerning access to funds should be verified through the
financial institution holding the account.
3. Verification of value: The CWA shall
verify the equity value of resources through appropriate and credible sources.
Additionally, the CWA shall evaluate the applicant's past circumstances and
present living standards in order to ascertain the existence of resources that
may not have been reported. If the applicant's resource statements are
questionable, or there is reason to believe the identification of resources is
incomplete, the CWA shall verify the applicant's resource statements through
one or more third parties.
i. Responsibility
of applicant: If the third-party contact is required in accordance with the
provisions above, the applicant shall cooperate fully with the verification
process. If necessary, the applicant shall provide written authorization
allowing the CWA to secure the appropriate information.
(e) Resource eligibility: Resource
eligibility is determined as of the first moment of the first day of each
month. If an individual or couple is resource ineligible as of the first moment
of the first day of the month, subsequent changes within that month in the
amount of countable resources will not affect the original determination of
ineligibility. If resource eligibility is established as of the first moment of
the first day of the month, resource eligibility is established for the entire
month regardless of any increase in the amount of countable resources.
1. This policy applies equally to individuals
and couples in the month of application. Regardless of the date of application,
resource eligibility is determined as of the first moment of the first day of
that month.
2. If, prior to the
first moment of the first day of the month, the applicant or beneficiary has
drawn a check (or equivalent instrument) on a checking or similar account, the
amount of such check shall reduce the value of the account. The value of such
accounts shall not be reduced by any unpaid obligations for which funds have
not already been committed by the drafting of a check.
i. When checks have been drawn on an account,
the CWA shall review the appropriate account registers or check stubs to
ascertain the actual balance as of the first moment of the first day of the
month. Full documentation of such circumstances is required.
(f) 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.
1. In order
for the cash reward to continue to be excluded, the funds shall be separately
identifiable (that is, not commingled with other funds or assets), but held in
a separate account. Any increase in the value of the excluded cash reward shall
also be excluded.
