Current through Register Vol. 56, No. 18, September 16, 2024
(a) Except as
specified below, countable income shall include the income of all members of
the household unit as determined at
10:78-3.5(a),
except that:
1. Income from a legally
responsible relative who does not reside with the family shall be counted only
to the extent that the income is actually made available to the household
unit;
2. A minor child who is in
receipt of Supplemental Security Income (SSI) shall not be included in the
household income;
3. Earned income
of a child who is a full or part-time student as defined in
10:69-10.15 shall be counted in
the household income.
i. For those
individuals who would qualify for AFDC-related Medicaid or NJ FamilyCare Plan A
except for alien residency restriction, earned income of a child who is a full
or part-time student as defined at
10:69-10.15 shall not be counted;
and
4. All wages paid by
the Census Bureau for temporary employment related to Census 2000 activities
shall be excluded from earned income.
(b) Income for purposes of determining
eligibility for NJ FamilyCare shall be determined as follows:
1. For self-employed persons, income shall be
calculated using adjusted gross income reported on the family's Federal income
tax form(s) from the prior year as the baseline and adding back in reported
depreciation, carryover loss, and net operating loss amounts that apply to the
business in which the family is currently engaged. Applicants shall report the
most recent financial situation of the family if it has changed from the period
of time covered by the Federal income tax form. The report may be in the form
of a percentage increase or decrease.
2. For wage earners, income shall be
calculated based on gross income reported in the month immediately preceding
application for NJ FamilyCare.
i. Income
received weekly shall be multiplied by 4.333 to determine the monthly amount;
biweekly income shall be multiplied by 2.167; variable amounts should be
averaged for the appropriate frequency (that is, weekly paychecks should have a
weekly average calculated: biweekly amounts should be averaged to determine a
biweekly average, etc.). That amount should then be multiplied by the
appropriate formula to determine monthly gross income. Other income should also
have the same methodology applied to determine monthly income.
3. For unemployed persons eligible
for a governmental income program, income shall be determined as it exists at
time of application, with notification of changes to be the responsibility of
the applicant. If income evaluated in this fashion renders an applicant
ineligible, documented cessation of the income source after the date of
application shall be considered.
4.
For other individual circumstances, income, including unearned income shall be
calculated based on a combination and/or variation of (b)1, 2 and/or 3 above,
as appropriate.
(c)
Nonrecurring lump sum income received by a household unit shall be added to any
other income received by the household unit in that month. The total shall be
divided by the income eligibility limit applicable to the household. The result
shall be the number of months the eligible members of the household unit shall
be ineligible to receive NJ FamilyCare under the provisions of this chapter.
Any remaining income from this calculation is treated as if it were unearned
income in the first month following the period of ineligibility.
1. The period of ineligibility shall begin
the first month subsequent to the month the nonrecurring income is received or,
if there is insufficient time to provide timely adverse action notice, the
following month.
2. Once
established, the period of ineligibility may be reduced only in accordance with
the AFDC provisions for shortening a period of ineligibility as found at
10:69-10.23. The basis for a
determination to shorten the period of ineligibility shall be fully documented
in the case record.
(d)
Any person who received AFDC-related Medicaid and became ineligible for such
assistance because of a period of ineligibility imposed as a result of the
provisions of
10:69-10.23 may establish
eligibility under the provisions of this chapter. The amount of the lump sum
used to determine the original period of ineligibility shall be divided by the
applicable income eligibility limit to determine the period of ineligibility
for NJ FamilyCare under this chapter. If that period has already expired,
eligibility for benefits under this chapter may be established so long as all
other eligibility criteria are met.
(e) The parents of an infant and the spouse
of a pregnant woman are legally responsible relatives of infants and pregnant
women applying for or eligible for benefits under the provisions of this
chapter. When a legally responsible relative resides in the same household, his
and/or her income is considered in the determination of eligibility and no
further action is required. When a legally responsible relative does not reside
in the same household, the eligibility determination agency shall pursue
support from that relative in accordance with the provisions of N.J.A.C.
10:69-10.
1. Except when the legally
responsible relative resides in the same household, income of the relative
shall be counted only to the extent that the income is actually made available
to the household unit.
(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.
