New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 71 - MEDICAID ONLY
Subchapter 5 - INCOME
Section 10:71-5.4 - Includable income
Universal Citation: NJ Admin Code 10:71-5.4
Current through Register Vol. 56, No. 18, September 16, 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.
(b) Countable income: Income remaining after appropriate income exclusions shall be applied toward the applicable income eligibility standard. The applicant's living arrangement affects the method of treatment of income and its relationship to the standards as stated in the variations appearing below.
1.
Applicant/beneficiary living alone: If the applicant/beneficiary lives alone,
only his or her countable income shall be applied to the appropriate income
standard.
2. Applicant/beneficiary
couple: In the case of an applicant/beneficiary couple, living together, the
total amount of husband's and wife's countable income shall be combined and
applied to the appropriate income eligibility standard for a couple. Such
individuals will continue to have their countable income combined until they
have been separated for a period of six months.
i. One member of couple institutionalized:
When one member of an applicant/beneficiary couple is institutionalized and the
other remains in the community, no income of the community spouse will be used
in the determination of income eligibility beginning in the month of admission
into a Title XIX facility.
ii.
Institutionalized couple: When an applicant/recipient couple is
institutionalized in the same facility, the gross income of each individual is
combined and applied to an amount equal to two times the Medicaid "Cap." If,
however, the applicant/recipient couple is institutionalized in separate
facilities, the income of each is applied individually to the Medicaid
"Cap."
3.
Applicant/beneficiary living with ineligible spouse: if the
applicant/beneficiary lives with an ineligible spouse, the income of the
ineligible spouse is deemed to the applicant/beneficiary (see
10:71-5.5) . Such individual's
income shall continue to be deemed until the husband and wife have been
separated for one month. At such time the individuals will be considered to be
living alone and deeming shall cease.
i.
Effect of institutionalization: Income of the community spouse shall not be
considered in the determination of income eligibility of the institutionalized
individual beginning with the month of admission into a Title XIX
facility.
4.
Applicant/beneficiary unmarried and under 18 years of age, living with parents:
If the applicant/recipient is an unmarried child under 18 years of age who
lives with his or her parents (including stepparents), the income of the
parents is deemed to the child (see
10:71-5.5(c)3 ) .
Such deeming will cease when a child has ceased living with his/her parents for
a period of one calendar month.
i. Child not
living with parents due to institutionalization: If a physician has certified
that the child's duration of stay in a Title XIX facility (or a combination of
such facilities) is expected to be a full calendar month or more, such child
shall be considered to be not living with his/her parents and deeming shall
cease at the time of such certification.
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