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Page 5 of 6 § 10:71-5.3 Income exclusions Community spouse of a nursing home resident was ineligible to receive any portion of the Social Security benefits paid to her husband and applied to his nursing home costs because she received a monthly gift of $ 3000 which, when taken with her other monthly income of $ 600, funded her independent living. Not only was there no basis for excluding the gift from the community spouse's income for the purpose of assessing her needs but there was no proof of exceptional circumstances justifying allocation, to the community spouse, of some part of the nursing home resident's Social Security benefits. T.D. v. Ocean Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 03009-14, 2015 N.J. AGEN LEXIS 390, Initial Decision (June 25, 2015). Denial of an 82-year old woman's application for Global Options (GO) Medicaid was appropriate. The applicant previously was receiving $ 2,055 a month from her husband under a Limited Judgment of Divorce from Bed and Board, which payment was claimed to be the applicant's share of the ratable portion of a former marital asset, not alimony. Prior to making the GO Medicaid application, however, the applicant applied for and was awarded a consent order decreasing the $ 2,055 monthly payment to $ 1,500. Though an Administrative Law Judge (ALJ) agreed with the applicant that those payments did not constitute alimony, she also concluded that they were not excludable as income under any provision of N.J.A.C. 10:71-5.3. Moreover, because the applicant's action to reduce the payments was admittedly taken to enable the applicant to remain in an assisted living setting, the facts triggered the application of N.J.A.C. 10:71-4.10(b)3. That is, her monthly income would be deemed to include the entire $ 2,055 rather than the reduced amount because the reduction was a result of action on the part of the applicant to meet eligibility guidelines. G.D. v. Burlington Cnty. Bd. of Social Servs. & DMAHS, OAL DKT. NO. HMA 2840-14, AGENCY DKT. NO. 0310031084, 2014 N.J. AGEN LEXIS 361, Initial Decision (June 20, 2014). An Administrative Law Judge (ALJ) concluded that the Division of Medical Assistance and Health Services had correctly determined that a disabled adult's income per N.J.A.C. 10:71-5.1 exceeded the eligibility limit of $ 2130 that applied to the Medicaid Only/Community Care Waiver and that the applicant thus was not entitled to benefits under that program. Applying the "countable income" regulations in N.J.A.C. 10:71-5.2(a), the ALJ determined that the applicant's gross monthly Social Security income of $ 1,372.90 and the applicant's gross monthly Defense Finance Accounting Service annuity of $ 848 were properly counted in their entirety because neither amount was excludable under N.J.A.C. 10:71-5.3. F.S. v. Div. of Med. Assistance & Health Servs., OAL DKT. NO. HMA 01924- 14, AGENCY REF. NO. 9020032857-01, 2014 N.J. AGEN LEXIS 321, Initial Decision (June 10, 2014). Adopting Initial Decision's conclusion that student loans were not includable as income for purposes of determining petitioner's Medicaid eligibility under the NJ FamilyCare program; a loan is a liability, not income, and including student loans as income defeats the purpose of the student loan program, as well as the underlying spirit and intent of assisting impoverished individuals (adopting with clarification 2007 N.J. AGEN LEXIS 188). K.F. v. DMAHS, OAL Dkt. No. HMA 12115-06, 2007 N.J. AGEN LEXIS 329, Final Decision (March 15, 2007). Court-ordered spousal support was nevertheless available income to applicant and otherwise countable toward determining Medicaid eligibility. L.M. v. Division of Medical Assistance, 95 N.J.A.R.2d (DMA) 51. Receipt of worker's compensation benefits causing loss of AFDC eligibility did not entitle recipient to 12-month extension of Medicaid eligibility. C.S. v. Morris County Board of Social Services, 94 N.J.A.R.2d (DEA) 1. Countable income reduced by child support. R.M. v. Division of Medical Assistance and Health Services, 93 N.J.A.R.2d (DMA) 41. Research References & Practice Aids LAW REVIEW AND JOURNAL COMMENTARIES: Medicaid. P.R. Chenoweth, 136 N.J.L.J. No. 14, 56 (1994). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law