Page 269

Page 6 of 9 § 10:71-5.7 Post-eligibility treatment of income; institutionalized individuals ALJ's finding that a county acted incorrectly when it denied a Medicaid application by an institutionalized spouse (since deceased) was rejected by DMAHS because the ALJ relied on cases relating to VA aid and attendance benefits, not the pension benefits that the spouse received. While the VA pension was not counted as part of the eligibility determination, it was properly considered in determining the spouse's post-eligibility treatment of income. Moreover, when the spousal impoverishment rules were applied to the correct calculation of post-eligibility income, it was clear that the spouse was not eligible for Medicaid benefits due to excess resources even without taking the VA pension into account. R.B. v. DMAHS et al., OAL DKT. NO. HMA 15134-2012, 2016 N.J. AGEN LEXIS 895, Final Administrative Determination (June 22, 2016). VA benefits payable to an institutionalized spouse that resulted from unusual medical expenses (UMEs) incurred by the institutionalized spouse were properly excluded as income in determining whether, per N.J.A.C. 10:71-4.8 and N.J.A.C. 10:71-5.7, the community spouse was entitled to an increased community spouse resource allowance. R.B. v. DMAHS and Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 15134-12, 2016 N.J. AGEN LEXIS 210, Initial Decision (April 15, 2016). Community spouse adequately established that she had financial duress by reason of her need to pay amounts owed to a nursing home where her husband resided, on account of his having been a resident at that nursing home from January 1, 2014 through March 11, 2015. That bill was the result of a redetermination of the monthly patient pay amount. Based on that convincing finding of financial duress, the community spouse was entitled to an upward adjustment in her community spouse maintenance to provide funds to pay that bill. B.G. v. Burlington Cnty. Bd. of Soc. Servs., OAL DKT. NO. HMA 7047-15, 2015 N.J. AGEN LEXIS 514, Initial Decision (November 5, 2015). 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). Community spouse was entitled to an increase in the community spouse maintenance deduction to alleviate financial duress because she incurred exceptional circumstances during the year at issue including a serious accident that generated unexpected out-of-pocket medical expenses, additional obligations incurred by the institutionalized spouse that increased his nursing home costs by $ 150 monthly, and an increase in the mortgage payment due on the community spouse's residence. E.B. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 5129-15, 2015 N.J. AGEN LEXIS 429, Initial Decision (July 13, 2015). 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). Spouse of an institutionalized person who was granted institutional Medicaid was not entitled to an increase in the amount of income allotted to her. Agency calculations showed that the community spouse needed $ 2,183.37 per month for maintenance and that after accounting for the spouse's income and personal social security benefit of $ 835.90 monthly, she was entitled to a community spouse maintenance deduction of $ 317.31 from her husband's funds. While the couple's son claimed that the funds available to the spouse after shelter expenses were deducted were insufficient to meet her needs, including transportation expense incurred in her job as a home health aide, the son presented no financial records or documentation of any expenses, and the record fell short of identifying any of the expenses that he testified to as being either extraordinary or unexpected. Because the record did not support the son's claim that his mother's expenses exceed her income, that her expenses were extraordinary, or that there