10:71-9.5 Eligibility for other programs
(a) Review: The CBOSS will review each MAAC case in accordance with (a)1 below for
potential eligibility for other assistance programs through which the costs of medical care
may be met. Those programs will not include General Assistance but will include such
programs as SSI and Medicaid Only.
1. Review times: The CBOSS will conduct a review with respect to other program eligibility
at time of initial certification, at the beginning of the review month, whenever any change in
client income occurs and at the time of any change in standards of other appropriate
programs.
(b) Referral: If eligibility is found for regular Medicaid Only, the CBOSS will convert the case
accordingly. If potential eligibility is found for a program administered by another agency,
the CBOSS will make referral promptly and will institute procedures for follow-up of the
referral. Upon acceptance of the individual into any other program through which medical
costs are met, the CBOSS will terminate the MAAC case.
Wednesday, July 15, 2009
10:71-9.4 Continuation of medical need
(a) Submittal of data to DMAHS/MRT: Thirty days prior to the end of each certification
period, the CBOSS will forward to DMAHS/MRT photocopies of all forms and reports
bearing on the individual's need for continued inpatient hospital services, skilled nursing
home services, or home health care services required by reason of an illness necessitating
confinement at home for a prolonged period.
(b) Response by DMAHS/MRT: The DMAHS/MRT will review the submitted material and
notify the CBOSS of its determination. The determination will specify whether continuation
does or does not exist.
(c) CBOSS Action: Upon receipt of the DMAHS/MRT determination the CBOSS will, as
appropriate, move to terminate or recertify the case for such periods as may be required to
make the review month become the final month of the new certification period.
(a) Submittal of data to DMAHS/MRT: Thirty days prior to the end of each certification
period, the CBOSS will forward to DMAHS/MRT photocopies of all forms and reports
bearing on the individual's need for continued inpatient hospital services, skilled nursing
home services, or home health care services required by reason of an illness necessitating
confinement at home for a prolonged period.
(b) Response by DMAHS/MRT: The DMAHS/MRT will review the submitted material and
notify the CBOSS of its determination. The determination will specify whether continuation
does or does not exist.
(c) CBOSS Action: Upon receipt of the DMAHS/MRT determination the CBOSS will, as
appropriate, move to terminate or recertify the case for such periods as may be required to
make the review month become the final month of the new certification period.
10:71-9.2 Initial certification
(a) Certification begins for those persons and only for those persons who were in certified
status in the MAA program at the close of business on June 30, 1982 and those persons
that filed MAA applications on or before June 30, 1982 and whose eligibility was established
in accordance with regulations and case circumstances in effect on that date. The initial
certification period in MAAC consists of the remainder of the current MAA certification period
(see N.J.A.C. 10:71-9.4(a)).
(b) Recertification: Eligible persons will be recertified by the CBOSS for such additional
periods, usually for three months or as specified by DMAHS/MRT (see N.J.A.C. 10:71-9.4).
(c) Extension of certification periods: The CBOSS will extend initial or subsequent
certification periods in units of one month as may be necessary, pending receipt of a
medical need determination from DMAHS/MRT and/or, if applicable, to comply with
requirements for timely notice of adverse action (see N.J.A.C. 10:71-8.3). Extensions shall
not be made for any other reasons
(a) Certification begins for those persons and only for those persons who were in certified
status in the MAA program at the close of business on June 30, 1982 and those persons
that filed MAA applications on or before June 30, 1982 and whose eligibility was established
in accordance with regulations and case circumstances in effect on that date. The initial
certification period in MAAC consists of the remainder of the current MAA certification period
(see N.J.A.C. 10:71-9.4(a)).
(b) Recertification: Eligible persons will be recertified by the CBOSS for such additional
periods, usually for three months or as specified by DMAHS/MRT (see N.J.A.C. 10:71-9.4).
(c) Extension of certification periods: The CBOSS will extend initial or subsequent
certification periods in units of one month as may be necessary, pending receipt of a
medical need determination from DMAHS/MRT and/or, if applicable, to comply with
requirements for timely notice of adverse action (see N.J.A.C. 10:71-8.3). Extensions shall
not be made for any other reasons
10:71-9.1 General statement
The Medical Assistance for the Aged Continuation (MAAC) provides payment for the costs
of medical services for certain former beneficiaries of the program of Medical Assistance for
the Aged (MAA). Eligibility is based on continued medical need and lack of eligibility for any
other program through which the cost of medical care is provided. Beneficiaries receive the
full spectrum of Medicaid services.
The Medical Assistance for the Aged Continuation (MAAC) provides payment for the costs
of medical services for certain former beneficiaries of the program of Medical Assistance for
the Aged (MAA). Eligibility is based on continued medical need and lack of eligibility for any
other program through which the cost of medical care is provided. Beneficiaries receive the
full spectrum of Medicaid services.
10:71-8.8 Nondiscrimination in public assistance programs
Title VI of the Federal Civil Rights Act of 1964 (Public Law 88-352) and Section 504 of the
Federal Rehabilitation Act of 1973 prohibit discrimination on the ground of race, color,
national origin, or handicap in the administration of a program for which Federal funds are
received. Therefore, the policies and procedures relating to those acts, as outlined in
N.J.A.C. 10:81-7.36 through 7.38 (nondiscrimination in public assistance programs) are to
be strictly observed.
Title VI of the Federal Civil Rights Act of 1964 (Public Law 88-352) and Section 504 of the
Federal Rehabilitation Act of 1973 prohibit discrimination on the ground of race, color,
national origin, or handicap in the administration of a program for which Federal funds are
received. Therefore, the policies and procedures relating to those acts, as outlined in
N.J.A.C. 10:81-7.36 through 7.38 (nondiscrimination in public assistance programs) are to
be strictly observed.
10:71-8.7 Safeguarding information
The Federal Social Security Act requires that a state must provide safeguards which restrict
the use or disclosure of information concerning applicants and beneficiaries to purposes
directly connected with the administration of public assistance. Therefore, the policies and
procedures outlined in N.J.A.C. 10:69-9.8 through 9.10 (safeguarding information) apply to
the Medicaid Only program.
The Federal Social Security Act requires that a state must provide safeguards which restrict
the use or disclosure of information concerning applicants and beneficiaries to purposes
directly connected with the administration of public assistance. Therefore, the policies and
procedures outlined in N.J.A.C. 10:69-9.8 through 9.10 (safeguarding information) apply to
the Medicaid Only program.
10:71-8.6 Reporting criminal offenses to law enforcement authorities
Investigation of new applications or investigations for redetermination or eligibility may on
occasion present indications to the CBOSS that a crime may have been committed. In such
a situation, the procedures outlined in N.J.A.C. 10:69-9.19 through 9.20 (reporting criminal
offenses to law enforcement authorities) are to be followed.
Investigation of new applications or investigations for redetermination or eligibility may on
occasion present indications to the CBOSS that a crime may have been committed. In such
a situation, the procedures outlined in N.J.A.C. 10:69-9.19 through 9.20 (reporting criminal
offenses to law enforcement authorities) are to be followed.
10:71-8.4 Complaints and fair hearings
(a) It is the right of every applicant for, or beneficiary of, Medicaid Only to be afforded the
opportunity for a fair hearing in the manner established by the policies and procedures set
forth in N.J.A.C. 10:49-10 and 10:69-6, regarding complaints and fair hearings (see N.J.A.C.
1:1). Complaints and fair hearings regarding Medicaid Only eligibility should be referred to:
Division of Medical Assistance and Health Services
Office of Legal and Regulatory Liaison
PO Box 712
Mail Code #3
Trenton, New Jersey 08625-0712
(b) In situations where an applicant or recipient is denied medical services to which he or
she feels that he or she is entitled, a request for a hearing and a brief explanation of the
situation should likewise be sent to the Office of Legal and Regulatory Liaison
(a) It is the right of every applicant for, or beneficiary of, Medicaid Only to be afforded the
opportunity for a fair hearing in the manner established by the policies and procedures set
forth in N.J.A.C. 10:49-10 and 10:69-6, regarding complaints and fair hearings (see N.J.A.C.
1:1). Complaints and fair hearings regarding Medicaid Only eligibility should be referred to:
Division of Medical Assistance and Health Services
Office of Legal and Regulatory Liaison
PO Box 712
Mail Code #3
Trenton, New Jersey 08625-0712
(b) In situations where an applicant or recipient is denied medical services to which he or
she feels that he or she is entitled, a request for a hearing and a brief explanation of the
situation should likewise be sent to the Office of Legal and Regulatory Liaison
10:71-8.2 Redetermination of medical eligibility
(a) Redetermination of disability and blindness factors shall be done for every Medicaid
Only beneficiary at intervals set by the Division of Medical Assistance and Health Services,
Medical Review Team (MRT), except those beneficiaries who are currently receiving SSA
Disability Insurance Benefits. The redetermination review date is designated on Form PA-8,
Record of Action: Medical Eligibility Factor (see N.J.A.C. 10:71-3.13(g)).
(b) An individual who has been determined to be disabled or statutorily blind shall, if
requested with reasonable notice, present himself or herself for and submit to examinations
or tests, and shall submit medical and other evidence necessary for the purpose of
determining whether he or she continues to be disabled or statutorily blind.
(c) In Medicaid Only cases, the CBOSS shall take into account the redetermination review
date on Form PA-8 in scheduling both the annual review and interim visits. The CBOSS
may adjust the date for case submittal to the Medical Review Team (MRT), to coincide as
closely as is practical with either the annual review or with an interim visit, but such
adjustment shall assure that the case will be submitted not more than two months earlier
and in no event later than the date originally set on Form PA-8.
(d) The Medical Review Team (MRT) will maintain a control file in order to ensure
appropriate and timely reevaluation by the medical review team (MRT). The Medical Review
Team (MRT) will notify county board of social services one month in advance of cases
scheduled for such review by means of Form PA-655, Cases for Medical Review Team
Reevaluation Due During the Month.
(e) The eligibility worker shall organize his or her caseload controls (notebooks, index, and
other related materials or equipment) so that he or she will be alerted sufficiently in advance
of redetermination review dates to enable him or her to obtain any specific medical
information or reports requested on the last Form PA-8. The data and reports so submitted
must be "current."
(f) When a case is to be submitted to the Medical Review Team (MRT) for redetermination
review, the eligibility worker shall prepare Form PA-6A, Interim Medical Social Report in
detail. Form PA-6A shall be placed on top of all forms, reports and related data previously
submitted.
(g) Medicaid coverage shall be continued, if financial and resource eligibility continues to exist, unless and until the CBOSS is advised by the Medical Review Team (MRT) that the
individual no longer meets the disability and blindness requirements or the individual
withdraws voluntarily.
(h) Upon receipt of records from the Medical Review Team (MRT), the CBOSS shall follow
the procedures as outlined in N.J.A.C. 10:71-3.13(g)
(a) Redetermination of disability and blindness factors shall be done for every Medicaid
Only beneficiary at intervals set by the Division of Medical Assistance and Health Services,
Medical Review Team (MRT), except those beneficiaries who are currently receiving SSA
Disability Insurance Benefits. The redetermination review date is designated on Form PA-8,
Record of Action: Medical Eligibility Factor (see N.J.A.C. 10:71-3.13(g)).
(b) An individual who has been determined to be disabled or statutorily blind shall, if
requested with reasonable notice, present himself or herself for and submit to examinations
or tests, and shall submit medical and other evidence necessary for the purpose of
determining whether he or she continues to be disabled or statutorily blind.
(c) In Medicaid Only cases, the CBOSS shall take into account the redetermination review
date on Form PA-8 in scheduling both the annual review and interim visits. The CBOSS
may adjust the date for case submittal to the Medical Review Team (MRT), to coincide as
closely as is practical with either the annual review or with an interim visit, but such
adjustment shall assure that the case will be submitted not more than two months earlier
and in no event later than the date originally set on Form PA-8.
(d) The Medical Review Team (MRT) will maintain a control file in order to ensure
appropriate and timely reevaluation by the medical review team (MRT). The Medical Review
Team (MRT) will notify county board of social services one month in advance of cases
scheduled for such review by means of Form PA-655, Cases for Medical Review Team
Reevaluation Due During the Month.
(e) The eligibility worker shall organize his or her caseload controls (notebooks, index, and
other related materials or equipment) so that he or she will be alerted sufficiently in advance
of redetermination review dates to enable him or her to obtain any specific medical
information or reports requested on the last Form PA-8. The data and reports so submitted
must be "current."
(f) When a case is to be submitted to the Medical Review Team (MRT) for redetermination
review, the eligibility worker shall prepare Form PA-6A, Interim Medical Social Report in
detail. Form PA-6A shall be placed on top of all forms, reports and related data previously
submitted.
(g) Medicaid coverage shall be continued, if financial and resource eligibility continues to exist, unless and until the CBOSS is advised by the Medical Review Team (MRT) that the
individual no longer meets the disability and blindness requirements or the individual
withdraws voluntarily.
(h) Upon receipt of records from the Medical Review Team (MRT), the CBOSS shall follow
the procedures as outlined in N.J.A.C. 10:71-3.13(g)
10:71-8.1 Other agency responsibilities
(a) Determination of continuing eligibility: The eligibility of each case shall be redetermined
at least once every 12 months. This redetermination provides an opportunity to evaluate the
total situation and enables the eligibility worker to ascertain whether the individual's eligibility
has changed.
1. It shall be the agency's responsibility to review indications of ineligibility as they occur
and to discontinue Medicaid Only eligibility when appropriate and without delay. The agency
shall notify each applicant/beneficiary of any agency decision that relates to his or her
eligibility status in accordance with the provisions of (d) below and 8.3.
2. The individual, or his or her authorized representative, shall execute a formal written
application, Form PA-1G, Application and Affidavit for Medical Assistance Only (Aged, Blind,
or Disabled), for continuance of assistance at least once every 12 months.
(b) Process of redetermination:
1. Redeterminations of eligibility require the completion of Form PA-1G-NJR2
(Redetermination Form). The CBOSS may require that the form be completed during a faceto-
face interview. However, at the option of the CBOSS, and with the approval of the
beneficiary, the face-to-face interview may be eliminated. Form PA-1G-NJR2
(Redetermination Form) may be mailed to and completed by the beneficiary and mailed to
the CBOSS. All factors of eligibility subject to change (with the exception of disability and
blindness factors) must be verified or reverified.
i. When a loss of assistance will result, the face-to-face interview shall be required, unless
the agency documents a clear refusal by the beneficiary to have a face-to-face meeting.
Before benefits are terminated, a beneficiary shall be offered a face-to-face home visit. The
visit shall not be required to be in the office, but at the beneficiary's request, in the home.
2. Redetermination of financial and resource eligibility: The eligibility worker shall review all
eligibility factors in accordance with the provisions set forth in N.J.A.C. 10:71-3, 4, and 5.
Particular attention shall be directed to identification of any changes in resources and
income.
3. Completion of the Medicaid Eligibility Worksheet: It is the responsibility of the eligibility
worker to complete a new Form PA-1E when eligibility is to be continued, or terminated. A
PR-1 Statement of Income Available for Long Term Care Facility Payment should be
prepared for persons in institutions only when there is a change with regard to the amount
of income available for medical reimbursement.
4. Need for institutional care: Official review of this factor on a routine basis is not required,
but when medical or social evidence indicates that specific determination should be made,
the CBOSS shall institute such an investigation.
(c) Recording and recommendation: A Summary Report, Form PA-2D, concerning all
pertinent information shall be completed for each contact with the individual, whenever it
occurs. Whenever a change in circumstances affects any facet of eligibility, a Medicaid
Eligibility Worksheet (Form PA-1E) shall be prepared. The summary shall clearly state the basis for any termination of eligibility. Following each redetermination of eligibility, it is the
responsibility of the eligibility worker to recommend that eligibility be continued or
terminated.
(d) Notice of agency decision: Each applicant/beneficiary shall receive written notice of any
agency decision which relates to his or her eligibility status at least 10 days prior to any
change in his or her eligibility status.
(a) Determination of continuing eligibility: The eligibility of each case shall be redetermined
at least once every 12 months. This redetermination provides an opportunity to evaluate the
total situation and enables the eligibility worker to ascertain whether the individual's eligibility
has changed.
1. It shall be the agency's responsibility to review indications of ineligibility as they occur
and to discontinue Medicaid Only eligibility when appropriate and without delay. The agency
shall notify each applicant/beneficiary of any agency decision that relates to his or her
eligibility status in accordance with the provisions of (d) below and 8.3.
2. The individual, or his or her authorized representative, shall execute a formal written
application, Form PA-1G, Application and Affidavit for Medical Assistance Only (Aged, Blind,
or Disabled), for continuance of assistance at least once every 12 months.
(b) Process of redetermination:
1. Redeterminations of eligibility require the completion of Form PA-1G-NJR2
(Redetermination Form). The CBOSS may require that the form be completed during a faceto-
face interview. However, at the option of the CBOSS, and with the approval of the
beneficiary, the face-to-face interview may be eliminated. Form PA-1G-NJR2
(Redetermination Form) may be mailed to and completed by the beneficiary and mailed to
the CBOSS. All factors of eligibility subject to change (with the exception of disability and
blindness factors) must be verified or reverified.
i. When a loss of assistance will result, the face-to-face interview shall be required, unless
the agency documents a clear refusal by the beneficiary to have a face-to-face meeting.
Before benefits are terminated, a beneficiary shall be offered a face-to-face home visit. The
visit shall not be required to be in the office, but at the beneficiary's request, in the home.
2. Redetermination of financial and resource eligibility: The eligibility worker shall review all
eligibility factors in accordance with the provisions set forth in N.J.A.C. 10:71-3, 4, and 5.
Particular attention shall be directed to identification of any changes in resources and
income.
3. Completion of the Medicaid Eligibility Worksheet: It is the responsibility of the eligibility
worker to complete a new Form PA-1E when eligibility is to be continued, or terminated. A
PR-1 Statement of Income Available for Long Term Care Facility Payment should be
prepared for persons in institutions only when there is a change with regard to the amount
of income available for medical reimbursement.
4. Need for institutional care: Official review of this factor on a routine basis is not required,
but when medical or social evidence indicates that specific determination should be made,
the CBOSS shall institute such an investigation.
(c) Recording and recommendation: A Summary Report, Form PA-2D, concerning all
pertinent information shall be completed for each contact with the individual, whenever it
occurs. Whenever a change in circumstances affects any facet of eligibility, a Medicaid
Eligibility Worksheet (Form PA-1E) shall be prepared. The summary shall clearly state the basis for any termination of eligibility. Following each redetermination of eligibility, it is the
responsibility of the eligibility worker to recommend that eligibility be continued or
terminated.
(d) Notice of agency decision: Each applicant/beneficiary shall receive written notice of any
agency decision which relates to his or her eligibility status at least 10 days prior to any
change in his or her eligibility status.
10:71-7.5 Payment of burial and funeral expenses
The county board of social services is directed, under certain situations, to provide
payments for burial and funeral expenses on behalf of Supplemental Security Income and
adult "Medicaid Only" beneficiaries, as well as former Old Age Assistance, Disability
Assistance and Assistance for the Blind beneficiaries. The procedure authorizing these
payments is located at N.J.A.C. 10:90-8.
The county board of social services is directed, under certain situations, to provide
payments for burial and funeral expenses on behalf of Supplemental Security Income and
adult "Medicaid Only" beneficiaries, as well as former Old Age Assistance, Disability
Assistance and Assistance for the Blind beneficiaries. The procedure authorizing these
payments is located at N.J.A.C. 10:90-8.
10:71-7.3 Other service payments
Eligible applicants and beneficiaries of Medicaid Only are also eligible to receive certain
service payments as authorized at N.J.A.C. 10:69-10.22(b) and 10.23. These include
payments for expenses incident to homemaker service, travel costs for health care, and
childcare in certain situations.
Eligible applicants and beneficiaries of Medicaid Only are also eligible to receive certain
service payments as authorized at N.J.A.C. 10:69-10.22(b) and 10.23. These include
payments for expenses incident to homemaker service, travel costs for health care, and
childcare in certain situations.
10:71-7.2 Services and service payments
Eligible applicants and beneficiaries as defined under the State Plan for Title XX of the
Social Security Act may receive the services and related service payments specified in the
State Plan. The Division of Youth and Family Services is responsible for providing the
county board of social services with policies and procedures regarding these service
programs, including those specified in N.J.A.C. 10:71-7.3.
Eligible applicants and beneficiaries as defined under the State Plan for Title XX of the
Social Security Act may receive the services and related service payments specified in the
State Plan. The Division of Youth and Family Services is responsible for providing the
county board of social services with policies and procedures regarding these service
programs, including those specified in N.J.A.C. 10:71-7.3.
10:71-7.1 General provisions
Medicaid Only beneficiaries, like Supplemental Security Income (SSI) beneficiaries, are
eligible to receive services and related service payments for services identified at N.J.A.C.
10:71-7.2 and for payment of burial and funeral expenses as authorized by N.J.A.C. 10:71-
7.5. Such payments as deemed necessary and appropriate by the county board of social
services shall be paid either directly to the vendor of the service or by a check issued to the
eligible person.
Medicaid Only beneficiaries, like Supplemental Security Income (SSI) beneficiaries, are
eligible to receive services and related service payments for services identified at N.J.A.C.
10:71-7.2 and for payment of burial and funeral expenses as authorized by N.J.A.C. 10:71-
7.5. Such payments as deemed necessary and appropriate by the county board of social
services shall be paid either directly to the vendor of the service or by a check issued to the
eligible person.
10:71-6.1 Purpose of case records
The case record is a complete record in support of the CBOSS's decisions and actions for
each case.
10:71-6.2 Contents of the case record
(a) The following items shall be included in the case record:
1. The narrative recording;
2. All medical reports and record of action from the MRT (appropriate cases);
3. All forms related to financial eligibility; and
4. All related correspondence, memoranda and documents except those which are
required by law and regulation to be maintained in some other files.
10:71-6.3 Forms applicable to the Medicaid Only program
Forms applicable to the Medicaid Only program (aged, blind and disabled) are listed on
page 1 of Appendix A; sample forms follow that list.
10:71-6.4 Maintenance and custody of case records
All case record material relevant to each family shall be maintained under an appropriate
registration number. All records shall be appropriately indexed and filed.
10:71-6.5 Movement of case records
(a) No case record or official part of such record shall be removed from its designated filing
cabinet without an identifying record of the person who has custody of it.
(b) No case record or official part shall be removed from the offices of the county welfare
board except at the specific authorization of the director, deputy director or duly designated
representative of the director.
10:71-6.6 Retention and destruction of records
For policy and procedure on retention and destruction of case records see N.J.A.C. 10:69.
The case record is a complete record in support of the CBOSS's decisions and actions for
each case.
10:71-6.2 Contents of the case record
(a) The following items shall be included in the case record:
1. The narrative recording;
2. All medical reports and record of action from the MRT (appropriate cases);
3. All forms related to financial eligibility; and
4. All related correspondence, memoranda and documents except those which are
required by law and regulation to be maintained in some other files.
10:71-6.3 Forms applicable to the Medicaid Only program
Forms applicable to the Medicaid Only program (aged, blind and disabled) are listed on
page 1 of Appendix A; sample forms follow that list.
10:71-6.4 Maintenance and custody of case records
All case record material relevant to each family shall be maintained under an appropriate
registration number. All records shall be appropriately indexed and filed.
10:71-6.5 Movement of case records
(a) No case record or official part of such record shall be removed from its designated filing
cabinet without an identifying record of the person who has custody of it.
(b) No case record or official part shall be removed from the offices of the county welfare
board except at the specific authorization of the director, deputy director or duly designated
representative of the director.
10:71-6.6 Retention and destruction of records
For policy and procedure on retention and destruction of case records see N.J.A.C. 10:69.
10:71-5.9 Deeming from sponsor to alien
(a) For the purposes of determining eligibility for Medicaid Only for a legal alien (applying
for the first time on or after October 1, 1980), the income and resources (see N.J.A.C.
10:71-4.7) of any person who sponsored the alien's entry into the United States will be
deemed to the alien. Such deeming applies for a period of three years from the month of
the alien's entry into the United States. However, deeming shall not apply to any alien who
is:
1. Admitted to the United States under the provisions of section 203(a)(7) of the
Immigration and Nationality Act which were in effect prior to April 1, 1980;
2. Admitted to the United States under the provisions of section 207(c)(1) of such Act
which became effective March 31, 1980;
3. Paroled into the United States as a refugee under section 212(d)(5) of such Act;
4. Granted political asylum by the Attorney General;
5. Determined to be blind or disabled if such blindness or disability began after the date of
admission into the United States for permanent residence; or
6. Sponsored by an institutional sponsor such as an employer or a church.
(b) In the event an alien is sponsored by a person subject to the deeming rules at N.J.A.C.
10:71-5.5, those rules will be used in lieu of the sponsor-to-alien rules.
(c) No inquiry shall be made regarding a sponsor's financial circumstance unless the alien's
own countable income and resources indicate potential program eligibility.
(d) Normal income exclusions do not apply in deeming of a sponsor's income to an alien.
Additionally, SSI benefits, TANF payments, as well as any other public income maintenance
payments are not excluded in sponsor-to-alien deeming.
(e) To determine the amount of income to be deemed to an alien, the dollar amounts in (e)2
and 3 below will be updated annually by publication of a notice of administrative changes in
the New Jersey Register reflecting the Federal cost-of-living adjustment to the SSI
standards established pursuant to 42 U.S.C. § 1382f. The CBOSS shall proceed as follows:
1. Determine the total gross earned (wages and net earnings from self employment) and
gross unearned income of the sponsor (and spouse if living with the sponsor).
2. Subtract $564.00 for the sponsor, $846.00 for the sponsor if living with his or her
spouse, $1,128 for the sponsor if his or her spouse is a co-sponsor.
3. Subtract $282.00 for any other dependent of the sponsor who is or could be claimed for
Federal Income Tax purposes.
4. The remaining amount is deemed as unearned income to the alien.
(f) In the event that a sponsor has sponsored more than one alien, there is no proration of
deemable income among the sponsored aliens. The income is fully charged to each alien
for which the sponsor has executed an affidavit of support.
(a) For the purposes of determining eligibility for Medicaid Only for a legal alien (applying
for the first time on or after October 1, 1980), the income and resources (see N.J.A.C.
10:71-4.7) of any person who sponsored the alien's entry into the United States will be
deemed to the alien. Such deeming applies for a period of three years from the month of
the alien's entry into the United States. However, deeming shall not apply to any alien who
is:
1. Admitted to the United States under the provisions of section 203(a)(7) of the
Immigration and Nationality Act which were in effect prior to April 1, 1980;
2. Admitted to the United States under the provisions of section 207(c)(1) of such Act
which became effective March 31, 1980;
3. Paroled into the United States as a refugee under section 212(d)(5) of such Act;
4. Granted political asylum by the Attorney General;
5. Determined to be blind or disabled if such blindness or disability began after the date of
admission into the United States for permanent residence; or
6. Sponsored by an institutional sponsor such as an employer or a church.
(b) In the event an alien is sponsored by a person subject to the deeming rules at N.J.A.C.
10:71-5.5, those rules will be used in lieu of the sponsor-to-alien rules.
(c) No inquiry shall be made regarding a sponsor's financial circumstance unless the alien's
own countable income and resources indicate potential program eligibility.
(d) Normal income exclusions do not apply in deeming of a sponsor's income to an alien.
Additionally, SSI benefits, TANF payments, as well as any other public income maintenance
payments are not excluded in sponsor-to-alien deeming.
(e) To determine the amount of income to be deemed to an alien, the dollar amounts in (e)2
and 3 below will be updated annually by publication of a notice of administrative changes in
the New Jersey Register reflecting the Federal cost-of-living adjustment to the SSI
standards established pursuant to 42 U.S.C. § 1382f. The CBOSS shall proceed as follows:
1. Determine the total gross earned (wages and net earnings from self employment) and
gross unearned income of the sponsor (and spouse if living with the sponsor).
2. Subtract $564.00 for the sponsor, $846.00 for the sponsor if living with his or her
spouse, $1,128 for the sponsor if his or her spouse is a co-sponsor.
3. Subtract $282.00 for any other dependent of the sponsor who is or could be claimed for
Federal Income Tax purposes.
4. The remaining amount is deemed as unearned income to the alien.
(f) In the event that a sponsor has sponsored more than one alien, there is no proration of
deemable income among the sponsored aliens. The income is fully charged to each alien
for which the sponsor has executed an affidavit of support.
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