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Page 2 of 2 § 10:70-4.1 Medically Needy Income Levels Chapter Notes Case Notes Appeal by applicant for eligibility under Medicaid Nursing Home Program as of August 31, 2014 was properly dismissed because while the applicant showed clinical eligibility and the applicant's income satisfied either the budget unit or the medical spend down requirements in governing regulations, the applicant did not satisfy the resource limits until April 2015 and thus did not have eligibility until then. M.P. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 02517-16, 2017 N.J. AGEN LEXIS 163, Final Administrative Determination (March 16, 2017). Nursing home resident was Medicaid-eligible as of May 1, 2015 because her resources on that date totaled $ 719.63, well below the resource ceiling of $ 2,000. Her receipt of a $ 10,000 check later in that month on account of the settlement of a personal injury claim did not affect her eligibility for May 2015 as that was determined by law based on resources on the first day of the month. However, she became ineligible for Medicaid on June 1, 2015 because the account balance on that date exceeded the $ 2,000 ceiling. S.Y. v. Essex Cnty. Div. of Welfare, OAL DKT. NO. HMA 05261-16, 2016 N.J. AGEN LEXIS 250, Initial Decision (May 10, 2016). Initial Decision (2006 N.J. AGEN LEXIS 980) adopted, which found that although the term "gross income" is not specifically defined for the Medically Needy program found at N.J.A.C. 10:70-1.1 et seq., the Medicaid Only program does contain definitions for earned and unearned income under N.J.A.C. 10:71-5.1(b) and both N.J.A.C. 10:71-5.4 and N.J.A.C. 10:71-5.6 make reference to gross income; thus, while not a paradigm of clarity, the regulations imply that gross income is the proper figure to use in making eligibility determinations for the Medically Needy program as well as the Medicaid Only program. J.O. v. DMAHS, OAL Dkt. No. HMA 4407-06, 2006 N.J. AGEN LEXIS 935, Final Decision (October 24, 2006). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law End of Document