10:71-4.8 Institutional eligibility; resources of a couple
(a) In the determination of resource eligibility for an individual requiring long-term care, the
county board of social services shall establish the combined countable resources of a
couple as of the first period of continuous institutionalization beginning on or after
September 30, 1989. This determination shall be made upon request for a resource
assessment in accordance with N.J.A.C. 10:71-4.9 or at the time of application for Medicaid
benefits. The total countable resources of the couple shall include all resources owned by
either member of the couple individually or together. The county board of social services
shall establish a share of the resources to be attributed to the community spouse in
accordance with this section. (No community spouse's share of resources may be
established if the institutionalized individual's current continuous period of institutionalization
began at any time before September 30, 1989.)
1. The community spouse's share of the couple's combined countable resources is based
on the couple's countable resources as of the first moment of the first day of the month of
the current period of institutionalization beginning on or after September 30, 1989 and shall
not exceed $92,760, as indexed annually in accordance with 42 U.S.C. § 1396r-5(g) and
published as a notice in the New Jersey Register, and unless authorized in (a)4 or 5 below.
The community spouse's share of the couple's resources shall be the greater of:
i. $18,552, as indexed annually in accordance with 42 U.S.C. § 1396r-5(g) and published
as a notice in the New Jersey Register; or
ii. One half of the couple's combined countable resources.
2. In determining the resource eligibility of the institutionalized spouse, the community
spouse's share of the resources is subtracted from couple's total combined resources as of
the first moment of the first day of the month of application for Medicaid. If the remaining
resources are less than or equal to $2,000, the institutionalized spouse is resource eligible.
If the remaining resources exceed $2,000, eligibility may not be established.
i. In the case of an individual whose eligibility for institutional care is determined in
accordance with the rules applicable for New Jersey Care (see N.J.A.C. 10:72 et seq.),
resource eligibility will exist when the couple's combined resources, less the community
spouse's share of the resources, are equal to or less than $4,000.
3. To the extent that the community spouse's share of the combined resources are not
already owned by the community spouse, the ownership of the community spouse's share
of the resources must be transferred to the community spouse within 90 days of a
determination of eligibility for institutional Medicaid services. The CBOSS may extend the
transfer period if individual circumstances warrant a longer period to affect the transfer.
Resources not transferred by the end of the 90-day period (or extension) shall be counted in
the determination of eligibility for the institutionalized individual.
i. Eligibility for the institutionalized individual shall be established pending the actual
transfer of the resources if he or she attests, in writing, that he or she intends to transfer the
community spouse's share of the resources to the community spouse.
4. If a court of competent jurisdiction has ordered that resources be transferred to the
community spouse in an amount higher than that authorized in (a)1 above, the higher courtordered
amount shall be recognized as the community spouse's share. Any resource
transferred under such a court order shall not be subject to the resource transfer penalty
described at N.J.A.C. 10:71-4.7.
5. If, in accordance with N.J.A.C. 10:71-5.7(d), additional resources have been authorized
to be set aside for the community spouse in order to provide for a sufficient income
maintenance level, such additional resources are not subject to the limitation in this section
on the community spouse's share of the couple's combined resources. Any resource
transferred to the community spouse under this provision shall not be subject to the
resource transfer provision described at N.J.A.C. 10:71-4.7.
6. For purposes of this section, an institutionalized individual does not include any
individual who is not likely to remain in a Title XIX facility for a period of 30 consecutive
days. If a physician has not certified that the individual's stay in the facility is expected to be
a period of 30 or more consecutive days, that individual's Medicaid eligibility will be
determined as if he or she continued to reside in the community until he or she has been in
a Title XIX facility (or a combination of Title XIX facilities) for a period of 30 consecutive
days.
7. For purposes of this section, a continuous period of institutionalization means 30
consecutive days of institutional care in a medical institution, and/or Medicaid funded home
and community-based waiver services. Continuity is broken by absences from the
institution for 30 consecutive days or the non-receipt of home or community based services
for 30 consecutive days.
8. For purposes of determining the community spouse's share of the couple's resources
only, countable resources of a couple shall include all resources not subject to exclusion
under N.J.A.C. 10:71-4.4, except that one automobile shall be excluded without regard to
the dollar limits set forth at N.J.A.C. 10:71-4.4(b)2 and personal effects and household
goods shall be excluded without regard to the dollar limits set forth at N.J.A.C. 10:71-
4.4(b)3.
9. In determining retroactive eligibility (the three-month period immediately preceding the
month of application) based on the first Medicaid application in a continuous period of
institutionalization, the community spouse's share of the resources shall be deducted from
the couple's combined total resources. If the institutionalized individual subsequently files
another Medicaid application for the same continuous period of institutionalization,
retroactive eligibility will be based on all resources actually owned by the institutionalized individual.