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Page 3 of 9 § 10:71-5.7 Post-eligibility treatment of income; institutionalized individuals deduction may be applied against the individual's income for no longer than six months. This deduction may not be applied if a deduction has been made for the maintenance of a community spouse or other family member residing in that residence. 1. This deduction must be applied to the costs of maintaining the residence and may not be accumulated by the institutionalized individual. (i) If the institutionalized individual has health insurance covering himself or herself, the amount of the insurance premiums shall be deducted. 1. If the premium is billed other than monthly, the amount of the premium shall be prorated and deducted accordingly. 2. If the premium covers other individuals in addition to the institutionalized individual, only that portion of the premium attributable to the institutionalized individual shall be deducted. (j) No portion of a cash reward provided to any individual by the Division for providing information about fraud and/or abuse in any program administered in whole or in part by the Division shall be included in the computation of income for financial eligibility purposes. (k) Effective January 1, 2010, the following policy applies to post-eligibility medical deductions. 1. For necessary medical expenses as recognized by the Division and incurred during the three-month retroactive period or during a period of eligibility, the income adjustment is limited to the Medicaid fee in effect on the date of service. 2. If no Medicaid fee exists and the medical service is medically necessary and recognized by the Division, the income adjustment will be limited to the lesser of: i. The billed charge; ii. The fee under the largest commercial plan in New Jersey; or iii. Eighty percent of the Medicare fee schedule. 3. No deduction for medical and/or remedial care expenses shall be allowed for dates of service prior to the three-month retroactive period associated with the month of the Medicaid application. 4. No deduction for medical and/or remedial care expenses that were incurred during or as the result of the imposition of a transfer of assets penalty period shall be allowed. History HISTORY: New Rule, R.1991 d.32, effective January 22, 1991. See: 22 N.J.R. 7(a), 23 N.J.R. 215(b). Amended by R.2000 d.415, effective October 16, 2000. See: 32 N.J.R. 2565(a), 32 N.J.R. 3844(a). In the introductory paragraph of (c) and (g)2, increased dollar amounts from $ 856.00 to $ 1,383; and in (c)1, increased dollar amount from $ 257.00 to $ 414.00. Amended by R.2002 d.124, effective April 15, 2002. See: 33 N.J.R. 4188(a), 34 N.J.R. 1546(a). Added (j). Amended by R.2012 d.025, effective February 6, 2012.