Page 167

Page 7 of 8 § 10:71-4.8 Institutional eligibility; resources of a couple Community spouse was entitled to an additional allowance to be made as a part of her minimum monthly maintenance needs allowance (MMMNA) due to her deteriorating medical condition so that the spouse had funds to defray the costs of prescriptions and therapy. However, her MMMNA was not properly increased on account of other expenses such as utilities, credit card payments or lawn care nor could the MMMNA be increased to fund the retrofitting of the community spouse's existing home, which was estimated to cost more than $ 40,000. R.B. v. Warren Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 04303-15, 2015 N.J. AGEN LEXIS 688, Initial Decision (August 27, 2015). Spouse of a terminally ill husband met the "exceptional circumstances" standard of proof and was entitled to an increased Minimum Monthly Maintenance Needs Allowance equal to her spouse's net income after deduction for his personal-needs allowance, his medical insurance premiums, and any funds already paid to the spouse. "Exceptional circumstances" resulting in financial duress pursuant to 42 U.S.C.S. § 1396r-5(e)(2)(B) and cognate state law included the substantial debt she had already incurred to care for her husband and for her now-deceased minor child, who died from the same disease that now afflicted her husband, the fact that the facility in which her husband lived (and where he now was receiving hospice care) was suing her for $ 63,000, her limited earning opportunities, her own medical and dental problems. Under these circumstances, the amount otherwise allocable to the spouse as the "community spouse resource allowance" was demonstrably insufficient. R.L.W. v. DMAHS and Ocean Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 8511-10, 2014 N.J. AGEN LEXIS 825, Initial Decision (December 15, 2014). A county board of social services (CBSS) acted properly in denying Medicaid eligibility to a husband who was already a resident of a care center because the husband, who bore the burden of proof per N.J.A.C. 10:71-4.10(j), did not establish that sufficient verification of spend-down had been provided to CBSS. Moreover, the couple's resource assessment as determined per the criteria in N.J.A.C. 10:71-4.8(a) indicated total resources of $ 414,458.15, far in excess of the maximum for the husband, which was $ 211,229. R.K. v. Burlington Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 16823-13, AGENCY DKT. NO. 0310030815, 2014 N.J. AGEN LEXIS 341, Initial Decision (June 18, 2014). Resources of a Medicaid applicant's ex-wife that were acquired during the couple's 23-year separation but prior to their Pennsylvania divorce could not be considered as available to the applicant for the purpose of determining the countable resources of the couple pursuant to N.J.A.C. 10:71-4.8; the applicant's rights to those resources were determined by Pennsylvania law, and a valid Pennsylvania divorce decree was issued indicating that the applicant had no legal rights to those resources. S.P. v. DMAHS, OAL Dkt. No. HMA 10019-07, 2008 N.J. AGEN LEXIS 304, Initial Decision (April 14, 2008). Initial Decision (2007 N.J. AGEN LEXIS 189) adopted, which concluded that in calculating the Community Spouse Resource Allowance, repayments on home equity loans or lines of credit are not deductible as a shelter expense unless there is a direct relationship to preserving the marital home, such as when the loan proceeds are used for major repairs or capital improvements necessary to protect the home. A.F. v. DMAHS, OAL Dkt. No. HMA 12301- 06, 2007 N.J. AGEN LEXIS 330, Final Decision (May 24, 2007). Custodial bank accounts of Medicaid applicant's children were not available to applicant or her husband and thus were not countable resources in determining applicant's eligibility for the Nursing Home Medicaid program for the year in question. L.A.S. v. Union County Div. of Soc. Servs., OAL Dkt. No. HMA 1215-05, 2006 N.J. AGEN LEXIS 348, Initial Decision (April 26, 2006). Where trust property was described, in testimony, as the family home, and under the Trust Agreement co-trustees could in their sole discretion distribute all or any part of the trust principal reasonably necessary for the Settlor's care, support, and maintenance, and where a provision requiring the trustee to take into account any funds that may be available to the Settlor to meet those needs from any source other than the trust, which would presumably include Medicaid funds, flew in the face of the law and public policy, the applicant and his wife had resources in excess of the maximum permitted under the regulation. J.C. v. DMAHS, OAL Dkt. No. HMA 7550-05, 2006 N.J. AGEN LEXIS 349, Initial Decision (April 25, 2006).