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Page 2 of 2 § 10:70-6.1 Eligibility under medical spend-down History HISTORY: Amended by R.2006 d.364, effective October 16, 2006. See: 38 N.J.R. 2368(a), 38 N.J.R. 4480(c). In the introductory paragraph of (c), updated the N.J.A.C. reference. Annotations Notes 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). Though the agency failed to promptly process an application for Medicaid Only nursing home benefits and failed to advise the applicant of the reason for delay, the failure of the agency to advise the applicant of what needed to occur for eligibility to be determined was not grounds for an eligibility date that was earlier than that granted by the agency because the applicant was not resource-eligible earlier than the date awarded. W.H. v. Monmouth Cnty. Div. of Social Servs., OAL DKT. NO. HMA 10917-16, 2016 N.J. AGEN LEXIS 862, Initial Decision (October 19, 2016). Initial Decision (2006 N.J. AGEN LEXIS 980) adopted, which found that receipt of disability-related Social Security benefits (RSDI or SSDI) did not qualify a Medically Needy program applicant for Medically Needy spend-down analysis under N.J.A.C. 10:70-6.1; the regulation for spend-down eligibility requires the applicant to be a recipient of SSI (Supplemental Security Income), which is the Medicaid disability benefit available to low-income disabled individuals pursuant to Title XVI of the Social Security 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