R.S. VS. DIVISION OF MEDICAL ASSISTANCE AND
SERVICES A-5798-11T1 1/23/14In this appeal, we address an institutionalized Medicaid recipient's ability to shelter income for his non- institutionalized spouse. Here, the institutionalized petitioner appeals from a final agency decision of the Division of Medical Assistance and Health Services (Division) finding that the community spouse monthly income allowance (CSMIA) for his wife, D.S., should be calculated in accordance with 42 U.S.C.A. § 1396r-5(e)(2)(B) and N.J.A.C. 10:71-5.7(e), rather than pursuant to a Family Part separate maintenance order, which gave petitioner's spouse substantially more money per month than the amount calculated according to the CSMIA. Following our review, we conclude the Division, when determining the institutionalized spouse's obligation for his nursing home care, is not bound to abide by the terms of the separate maintenance order, entered in a non-contested proceeding, without notice to the Division, because the Order was designed to circumvent the regulations governing the CSMIA. We affirm the Division's decision.