Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 72 - NEW JERSEY CARE ... SPECIAL MEDICAID PROGRAMS MANUAL
Subchapter 4 - FINANCIAL ELIGIBILITY
Section 10:72-4.3 - Countable income: pregnant women and infants

N.J. Admin. Code § 10:72-4.3

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Current through Register Vol. 56, No. 21, November 4, 2024
Section 10:72-4.3 - Countable income: pregnant women and infants
(a) Except as specified below, countable income for pregnant women and infants under the provisions of this chapter shall include the income of all members of the household unit as determined at 10:72-3.5(a)1 and 2, and shall be determined in accordance with regulations applicable to income in the AFDC-C program in effect as of July 16, 1996 (see N.J.A.C. 10:69).
1. The maximum income limits as provided for at 10:69-10.3 do not apply.
2. Neither the $ 30.00 nor the one-third disregard of earned income at 10:69-10.13(c) apply.
3. The deeming of stepparent income at 10:69-10.33 does not apply. (See 10:72-3.5(a)2 regarding the inclusion or exclusion of the stepparent in the household unit.)
4. The deeming of an alien sponsor's income at 10:69-10.43 does not apply.
(b) Nonrecurring, lump-sum income received by a household unit of a pregnant woman or infant 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 will be the number of months the eligible members of the household unit shall be ineligible to receive Medicaid 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. No period of ineligibility shall apply to a pregnant women eligible under the provisions of this chapter.
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 N.J.A.C. 10:69. The basis for a determination to shorten the period of ineligibility shall be fully documented in the case record.
(c) Any person who received AFDC or Medicaid based on AFDC rules and became ineligible for such assistance because of a period of ineligibility imposed as a result of the provisions of N.J.A.C. 10:69 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 Medicaid 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.
(d) The parents of an infant who has applied for, or is eligible for, benefits under this chapter, shall be considered legally responsible relatives of the infant. The spouse of a pregnant woman who has applied for, or is eligible for, benefits under this chapter, shall be considered a legally responsible relative to the pregnant woman. When a legally responsible relative resides in the same household, his 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 county welfare agency shall pursue support from that relative in accordance with the provisions of N.J.A.C. 10:69.
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.
(e) 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.

N.J. Admin. Code § 10:72-4.3

Amended by R.1987 d.380, effective 8/27/1987.
See: 19 N.J.R. 1324(a), 19 N.J.R. 1731(a).
(c): missing text inserted.
Emergency Amendment, R.1988 d.96, effective 2/2/1988 (expired April 2, 1988).
See: 20 N.J.R. 548(a)
Adopted Concurrent Proposal, R.1988 d.212, effective 5/16/1988.
See: 20 N.J.R. 548(a), 20 N.J.R. 1103(a).
Emergency Amendment, R.1991 d.223, effective 3/28/1991 (operative April 1, 1991; expires May 27, 1991).
See: 23 N.J.R. 1200(a).
Adopted Federally required coverage pursuant to Omnibus Budget Reconciliation Act of 1989.
Adopted Concurrent Proposal, R.1991 d.302, effective 5/24/1991.
See: 23 N.J.R. 1200(a), 23 N.J.R. 1945(a).
Provisions of emergency amendment R.1991 d.223 readopted without change.
Amended by R.1992 d.364, effective 9/21/1992.
See: 24 N.J.R. 2145(a), 24 N.J.R. 3343(a).
Stylistic change.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
In (a), inserted "in effect as of July 16, 1996" following "program".
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2002 d.124, effective 4/15/2002.
See: 33 N.J.R. 4188(a), 34 N.J.R. 1546(a).
Added (e).
Amended by R.2008 d.30, effective 1/22/2008.
See: 39 N.J.R. 3704(a), 40 N.J.R. 723(a).
In (a), updated the N.J.A.C. references throughout; in the introductory paragraph of (b), inserted the comma following "Nonrecurring" and the hyphen following "lump"; in (b)2, updated the N.J.A.C. reference; in (c), updated the N.J.A.C. reference and inserted the comma following "established"; and rewrote the introductory paragraph of (d).