Current through Register Vol. 56, No. 6, March 18, 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.
