10:71-5.1 Income; financial eligibility standards
(a) As a condition of eligibility for the Medicaid Only Program, applicants must comply with
the income standards set forth in this subchapter (see N.J.A.C. 10:71-5.6).
(b) Income defined: For the purpose of this program, income shall be defined as receipt, by
the individual, of any property or service which he/she can apply, either directly or by sale or
conversion, to meet his/her basic needs for food, shelter,or clothing. All income, whether in
cash or in-kind, shall be considered in the determination of eligibility, unless such income is
specifically exempt under the provisions of N.J.A.C. 10:71-5.3
1. Availability of income: In order to be considered in the determination of eligibility,
income must be "available." Income shall be considered available to an individual when:
i. With the exception of income from self-employment, the individual actually receives the
income;
ii. With the exception of income from self-employment, the income becomes payable but is
not received by the individual due to his/her preference for voluntary deferment;
iii. Income has been deemed available to the applicant (see N.J.A.C. 10:71-5.5 regarding
the deeming of income);
iv. Net earnings from self-employment have been determined in accordance with N.J.A.C.
10:71-5.4(a)2.
2. Earned income: Earned income shall be defined as payment received by an individual
for services performed as an employee, or the net earnings as the result of selfemployment.
When the individual is both employed as self- employed, earned income shall
consist of gross wages (or salary, etc.) plus any net earnings from self-employment.
3. Unearned income: Unearned income shall be defined as any income which is not
coincident with the provisions of (b)2 above. This definition includes deemed income (see
N.J.A.C. 10:71-5.5).
(c) The grandfather clause: An individual (including an essential person) meeting the
criteria delineated in N.J.A.C. 10:71-4.5(e) may have his/her income eligibility determined in
accordance with the procedures formerly used in New Jersey's OAA, AB, and DA programs
if it is more advantageous (see Financial Assistance Manual, Chapter 300, for regulations in
effect prior to January 1, 1974).
10:71-5.2 Determination of countable income
(a) Countable income shall be determined by adding the applicant's nonexempt unearned
income (less appropriate exclusions) to his/her earned income (less appropriate exclusions).
(b) Procedures regarding the determination of income eligibility shall be as follows:
1. Determination of initial income eligibility shall be based on all earned and unearned
income which has or will be received during the month for which application is made,
beginning with the first day of such month, except that quarterly, semiannual, or annual
payments shall be prorated in accordance with (b)2 below. (See N.J.A.C. 10:71-5.3(a)15 regarding exclusion of student earnings.)
2. The following shall apply to income received other than monthly:
i. Income received weekly shall be multiplied by 4.333 to determine the monthly amount;
biweekly income shall be multiplied by 2.167. (If earned income is irregular, the initial
determination shall be based on the average of the amounts received for any four weeks
within the 10 week period which includes the five weeks immediately before and after the
date of application.)
ii. When income received on a quarterly, semi-annual, or annual basis is of sufficient
amount to affect the individual's eligibility, it shall be prorated as a monthly amount and
entered on the Medicaid Eligibility Worksheet (Form PA-1E) accordingly. (See also N.J.A.C.
10:71-5.4(a)11, regarding lump-sum payments.)
3. The period of income eligibility begins with the month in which application is made and
continues until the scheduled redetermination, or until a change in status or income occurs
which requires an earlier redetermination. (See N.J.A.C. 10:71-8.1(a), regarding
determination of continuing eligibility.)
4. At the time of application, the applicant shall identify any income which he or she
receives periodically (less frequently than once a month) or anticipates receiving prior to the
time of redetermination.
5. In situations where earned or unearned income is received irregularly or in irregular
amounts, redetermination shall be made as frequently as necessary. The individual shall be
advised of his or her responsibility to report significant changes in income. (See N.J.A.C.
10:71-5.3(a)12 regarding exclusion of certain irregular income.)