New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 71 - MEDICAID ONLY
Subchapter 5 - INCOME
Section 10:71-5.5 - Deeming of income
Universal Citation: NJ Admin Code 10:71-5.5
Current through Register Vol. 56, No. 18, September 16, 2024
(a) When an applicant/beneficiary is an adult residing in the same household with his or her ineligible spouse or is a child residing in the same household with his or her parent(s) or spouse of the parent, the income of the ineligible spouse or parent(s) is considered in the determination of financial eligibility. The amount included as income to the applicant/beneficiary, whether or not it is actually available, is called deemed income and is computed as described in 10:71-5.5(c), (d), (e) and (f).
1.
Child: For the purpose of this section, a child is an individual who is not
married and is under the age of 18 (see
10:71-5.3(a)15 i
regarding earnings of a child who is a student). Additionally, deeming of
parental income to a blind or disabled child ceases when the child reaches age
18.
2. Parent: A parent, for
deeming purposes, is a natural or adoptive parent or stepparent living in the
same household as an applicant/beneficiary child. However, death or divorce of
the natural or adoptive parent terminates deeming responsibility of a
stepparent.
(b) Items not included in deeming: In determining the income of an ineligible spouse, parent and/or spouse of a parent, or income of any ineligible children in the household, the following are not included as income:
1. Any assistance based on need and any
income considered in the determination of the amount of such
assistance;
2. That portion of any
grant, scholarship, or fellowship, used to pay the cost of tuitions and fees at
an educational institution or costs of vocational technical training designed
to prepare the individual for gainful employment;
3. Amounts received for foster care of an
ineligible child;
4. The value of
food stamps or U.S. Department of Agriculture donated foods (e.g., supplemental
food programs);
5. Home produce
grown for personal consumption;
6.
Refund of taxes paid on income, real property, or food purchased by the
family;
7. Such income used to
comply with the terms of court-ordered support and support payments pursuant to
Title IV-D of the Social Security Act;
8. The value of in-kind support and
maintenance furnished to the ineligible spouse, ineligible parent(s) or
ineligible spouse of a parent, and ineligible children in the
household;
9. Income and benefits
received under certain Federal programs described in Section
10:71-5.3(a)7;
10. The earned income of an ineligible child
who is a student (subject to the limitations of
10:71-5.3(a)15,
unless the child actually makes the income available to the family);
11. Income necessary for a plan to achieve
self-support but only if the spouse's or parental income is actually being used
according to the plan to achieve self-support.
(c) Deeming of income from spouse to spouse: If the applicant's/beneficiary's own countable income, as determined in accordance with 10:71-5.2, less appropriate exclusions in 10:71-5.3, exceeds the applicable Medicaid Only income eligibility standard in Table B at 10:71-5.6(c)5, the applicant/beneficiary is financially ineligible for Medicaid Only based on his or her own countable income, and there is no deeming. However, if the applicant's/beneficiary's own countable income renders him or her financially eligible for Medicaid Only, the following steps shall be used to compute deemed income:
1. Step 1: Calculate separately the
ineligible spouse's earned and unearned income, less any income excluded in
accordance with
10:71-5.5(b). Do
not combine the two totals.
2. Step
2: Determine the living allowance for each ineligible child not receiving
public assistance, by subtracting the child's countable income from the amount
of the living allowance for an ineligible child in Table A, Figure 1.
3. Step 3: Subtract the living allowance for
each ineligible child, determined in Step 2 above, from the unearned income of
the ineligible spouse. Subtract any remaining living allowance from the earned
income of the ineligible spouse. For any ineligible child receiving public
assistance, no living allowance may be subtracted.
4. Step 4: If the total remaining income
(earned plus unearned) of the ineligible spouse is equal to or less than the
appropriate remaining income amount in Table A, Figure 2, no income is
available for deeming to the applicant/beneficiary. The deeming process stops.
i. Determine the beneficiary's income
eligibility for Medicaid Only by comparing his or her own countable income to
the appropriate Medicaid Only income eligibility standard in Table B at
10:71-5.6(c)5.
5. Step 5: If Step 4 above does
not apply, and the ineligible spouse's remaining total income (earned plus
unearned) exceeds the appropriate remaining income amount in Table A, Figure 2,
the deeming process continues and the applicant/beneficiary and his or her
ineligible spouse are treated as a couple. The following deeming steps shall be
used to compute the couple's countable income:
i. Add the ineligible individual's remaining
unearned income after the deduction of the living allowance for the ineligible
child(ren) to all of the beneficiary's unearned income. Determine the value of
in-kind support and maintenance in deeming situations, in accordance with
10:71-5.4(a)12.
(1) Do not apply the $ 20.00 general income
exclusion to the beneficiary individual's income before combining the
income.
ii. Add the
ineligible individual's remaining earned income after deduction of the living
allowance for the ineligible child(ren) to all of the applicant's/beneficiary's
earned income.
iii. Treat the two
totals of unearned and earned income in the same manner as those of an eligible
couple. Apply appropriate income exclusions and compute the couple's countable
income as follows:
(1) First, subtract the $
20.00 general income exclusion from the total unearned income. Then, subtract
any unused portion of the general income exclusion from the total earned
income, if any.
(2) From the
remaining earned income, subtract $ 65.00 (work expense allowance) and one-half
of the remainder of earned income.
(3) Add the remaining earned and unearned
income together to arrive at the couple's total countable income.
6. Step 6: If the
couple's (applicant/beneficiary and ineligible spouse) remaining countable
income is less than the amount in Table A, Figure 3, for the appropriate living
arrangement, the applicant/beneficiary is financially eligible for Medicaid
Only. If the couple's remaining income is equal to or greater than the amount
in Table A, Figure 3, for the appropriate living arrangement, the
applicant/beneficiary is financially ineligible for Medicaid Only.
(d) Deeming of income to spouse and child(ren): In situations when an ineligible individual is subject to deeming of his or her income to both an applicant/beneficiary spouse and an applicant/beneficiary child, the following deeming procedures are used:
1. Step 1: Determine the amount of income, if
any, to be deemed to the applicant/beneficiary spouse in accordance with the
procedures in
10:71-5.5(c).
2. Step 2: If, after deeming of income from
the ineligible spouse, the adult applicant/beneficiary is financially eligible
for Medicaid Only, there is no income available for deeming to the
applicant/beneficiary child(ren). The deeming process stops.
3. Step 3: If, in the process of deeming of
income to the applicant/beneficiary spouse, such spouse becomes financially
ineligible for Medicaid Only, that portion of deemed income that exceeds the
eligibility level in Table A, Figure 3, for the appropriate living arrangement
for the adult applicant/beneficiary shall be deemed to any child
applicant/beneficiary. This income is treated as unearned income to the
child.
4. Step 4: If there is more
than one child applicant/beneficiary in the household, divide the deemable
income equally among them. However, income is not deemed to any child in excess
of that amount which, in combination with his or her own countable income,
creates financial ineligibility for the child. That portion of deemed income
that exceeds the eligibility level in Table B, for the appropriate living
arrangement, shall be available for deeming equally to any other
applicant/beneficiary child(ren) in the household (in accordance with Step 5
below) in addition to their equal shares of the total parental deemable
income.
5. Step 5: Combine any
income deemed to the eligible child together with any countable income of the
eligible child.
i. First, subtract the $ 20.00
general income exclusion from the child's unearned income.
ii. If the child's total income is less than
the appropriate income eligibility standard in Table B, the child is
financially eligible for Medicaid Only.
iii. If the child's total income is greater
than the appropriate income eligibility standard in Table B, the child is
financially ineligible for Medicaid Only, and that portion of deemed income
that exceeds the eligibility level in Table B, for the appropriate living
arrangement for the applicant/beneficiary child, shall be available for deeming
equally to any other applicant/beneficiary children in addition to their equal
shares of the total deemable income.
(e) Deeming of income from a parent (and spouse of a parent) to a child: The computation methods for deeming of income from an ineligible parent (and spouse of a parent) to a child differ depending on the type of parental income.
1. Step 1:
Determine the total monthly parental income, both earned and unearned
(separately), less any income excluded in
10:71-5.5(b). Do
not combine the two totals.
i. Determine the
living allowance for each ineligible child not receiving public assistance, by
subtracting the child's countable income from the amount of the living
allowance for an ineligible child in Table A, Figure 1. No allowance may be
deducted for a child receiving public assistance.
ii. Subtract the living allowance for each
ineligible child, determined in (e)1i above, from the unearned income of the
parent(s). Subtract any remaining living allowance from the earned income of
the parent(s).
iii. The remaining
parental income should be treated in accordance with the procedures of Step 2,
3, or 4 below, as appropriate.
2. Step 2: Remaining parental income is
earned income only:
i. From the remaining
parental earned income, subtract $ 85.00 ($ 20.00 general income exclusion plus
$ 65.00 work expense exclusion).
ii. Next, subtract the appropriate parental
living allowance for the parent (and spouse of a parent) living in the
household. This parental allowance is found in Table A, Figure 4a.
iii. The remaining amount is the income
deemed to the applicant/beneficiary child(ren). This deemed income is treated
as unearned income.
iv. Combine any
income deemed to the eligible child together with any countable income of the
eligible child.
(1) Subtract the $ 20.00
general income exclusion from the child's unearned income.
v. If the child's total countable income is
less than the appropriate income eligibility standard in Table B, the child is
financially eligible for Medicaid Only.
3. Step 3: Remaining parental income is
unearned only:
i. From the remaining parental
unearned income, subtract $ 20.00 (general income exclusion).
ii. Next, subtract the appropriate parent
living allowance for the parent (and spouse of a parent) living in the
household. This parental allowance is found in Table A, Figure 4b.
iii. The remaining amount is the income
deemed to the applicant/beneficiary child(ren). This deemed income is treated
as unearned income.
iv. Combine any
income deemed to the eligible child together with any countable income of the
eligible child.
(1) Subtract the $ 20.00
general income exclusion from the child's unearned income.
v. If the child's total income is less than
the appropriate income eligibility standard in Table B, the child is
financially eligible for Medicaid Only.
4. Step 4: Remaining parental income is both
earned and unearned:
i. First, subtract the $
20.00 general income exclusion from the remaining parental unearned income.
Then, subtract any unused portion of the general income exclusion from the
remaining parental earned income.
ii. From the remaining earned income,
subtract $ 65.00 (work expense allowance) and one-half of the remainder of
earned income. Combine any remaining earned income with the remaining unearned
income.
iii. Subtract the
appropriate parental living allowance for the parent (and spouse of parent)
living in the household. This parental allowance is found in Table A, Figure
4c.
iv. The remaining amount is the
income deemed to the applicant/beneficiary child(ren). This deemed income is
treated as unearned income.
v.
Combine any income deemed to the eligible child together with any countable
income of the eligible child.
(1) Subtract
the $ 20.00 general income exclusion from the child's unearned
income.
vi. If the
child's total income is less than the appropriate income eligibility standard
in Table B, the child is financially eligible for Medicaid Only.
(f) Treatment of income deemed to a child: Any income deemable to a child is treated as unearned income and thus subject to the $ 20.00 general income exclusion. If there is more than one applicant/beneficiary child in the household, the deemable income is divided equally among them. However, no income is to be deemed in excess of the amount which, when combined with the child's own countable income, creates ineligibility. That portion of deemed income that exceeds the eligibility level in Table B, for the appropriate living arrangement, is available for deeming equally to other applicant/beneficiary children in the household in addition to their equal shares of the total parental deemable income. The following steps shall apply in treatment of income deemed to a child:
1. Step 1: Combine any income deemed to the
eligible child together with any countable income of the eligible
child.
2. Step 2: Subtract the $
20.00 general income exclusion from the child's unearned income.
3. Step 3: If the child's total remaining
income is less than the appropriate income eligibility standard in Table B the
child is financially eligible for Medicaid Only. The child has no excess deemed
income available for other applicant/beneficiary children.
4. Step 4: If, in the process of deeming of
income to an applicant/beneficiary child, such child becomes financially
ineligible for Medicaid Only, that portion of deemed income that exceeds the
appropriate income eligibility standard in Table B shall be divided equally
among other applicant/beneficiary children in the household, in addition to
their equal shares of the total parental deemable income, and shall be counted
in determining financial eligibility for Medicaid Only for such other
children.
(g) Table A which follows shall be used in deeming computation amounts. Table A will be revised annually in accordance with Federal cost-of-living adjustments made pursuant to 42 U.S.C. § 1382(f). A notice of administrative changes containing the revisions will be published annually in the New Jersey Register.
| Table A | |
| Deeming Computation Amounts | |
| 1. Living allowance for each ineligible child | $ 361.00 |
| 2. Remaining income amount | |
| Head of Household | Receiving Support and Maintenance |
| $ 360.50 | $ 240.67 |
| 3. Spouse to Spouse Deeming--Eligibility Levels | |
| a. Residential Health Care Facility | $ 1,820.36 |
| b. Eligible Individual Living Alone or with Ineligible Spouse | $ 1,235.00 |
| c. Living Alone or with Others | $ 1,113.25 |
| d. Living in the Household of Another | $ 814.43 |
| 4. Parental Allowance--Deeming to Children Remaining Income is: | |
| One Parent | Parent and Spouse of Parent | |
| a. Earned only | $ 1,442.00 | $ 2,164.00 |
| b. Unearned only | $ 721.00 | $ 1,082.00 |
| c. Both earned and unearned | $ 721.00 | $ 1,082.00 |
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