N.J. Admin. Code § 10:46D-3.1 - DDD Formula A-DDD(A) for persons over age 18

(a) Individuals over age 18 without financial dependents who have unearned income shall contribute in accordance with the following Treasury Formula-DDD(A):

1. Total monthly net income less personal needs allowance (PNA) and, where documented, a plan to achieve self-support (PASS) = disposable monthly income.

i. Where an individual has a PASS, as defined in 20 C.F.R. 416.1226, and approved by the Social Security Administration, that amount shall be deducted from the total monthly net income.

ii. A copy of the PASS, as approved by the Social Security Administration, shall be provided to the Division by the individual.

iii. The PASS may be in effect for 18 months and may be extended for another 18 months up to an overall limit of 48 months, as approved by the Social Security Administration.

iv. The resources excluded under the PASS shall be deducted from the total monthly net income for the term of the plan, or until there is evidence that the time schedule has been completed, or the goal has been achieved, or the plan is not followed or the plan has been abandoned.

(b) Seventy-five percent of the disposable monthly income shall be contributed to the cost of care and maintenance. If the monthly contribution is less than $ 20.00, the contribution shall be waived.

(c) The individual, or his or her representative payee, is responsible to keep his or her accumulated funds under $ 2,000 to ensure continued eligibility for the Medicaid DDD Community Care Program benefits.

(d) Where an individual is required to contribute to a HUD rental, or otherwise pays directly for his or her housing costs as indicated in the Division's contract with the provider agency, that amount shall be deducted from the amount contributed to the cost of care and maintenance.

(e) A one-time allowance of up to $ 2,000 may be deducted from the contribution for the cost associated with the appointment of a private guardian. A copy of the court order shall be provided to the Division by the guardian, once the guardian has been appointed. If, for any reason, any part of the allowance is not used for the appointment of a guardian, the unused amount of the allowance may be collected in one sum at a time established by the Division.

(f) The individual may utilize up to six percent of his or her total gross annual income for the provision of private guardianship without court order. The six percent may be exceeded under court order for an additional percentage. This expense shall not be permitted where the Division provides guardianship through the Bureau of Guardianship Services.

(g) Any request to retain funds beyond 25 percent shall be based exclusively on the following circumstances. The request to retain additional funds shall be made to the case manager, be reviewed by the IDT team and approved by the assigned State business office. Retention of additional funds is subject to the annual reassessment. The individual or representative payee shall provide verification of the extraordinary need which shall be limited to the following circumstances:

1. The individual's reasonable costs related to food or shelter, including heat and utilities in a supervised apartment that exceed the amount provided in the agency contract;

2. Major "unavoidable" medical costs that are covered by Medicaid but exceed the frequency of service established by Medicaid or other unavoidable medical costs as reviewed and approved by the Division;

3. Replacement of personal items due to destructive behavior based upon documentation in a specific behavior plan and not covered by the contract or third party;

4. For individuals who do not already have one, establishment of an irrevocable burial fund. The individual shall be permitted to retain no more than an additional 10 percent per month of the disposable income until such time as the burial contract is paid in full; and

5. For individuals who will move from a residential placement to independent living within six months, the individual may retain up to $ 2,000 to establish his or her household. Once the individual lives independently, he or she will have all his or her funds available; no contribution is required. The $ 2,000 must be spent as it is needed; the individual cannot accumulate these funds.

(h) All earnings from employment below minimum wage shall be exempt from determining an individual's available income and shall not be considered part of the individual's disposable income. Minimum wage is determined by the state in which an individual works. Contributions to the cost of care and maintenance from employment earnings at or above minimum wage shall be computed similar to the way in which the Social Security Administration counts earned income for Supplemental Security Income purposes. Contributions shall be determined, as follows:

1. The first $ 85.00 of wages earned each month shall be exempt from any contribution requirements;

2. After the first $ 85.00, one half of all wages earned will be excluded;

3. After one half of all wages earned are excluded, an additional one half of earnings are excluded because the individual's Supplemental Security Income cash benefit is reduced by one dollar for every two dollars earned; and

4. After this second exclusion, 30 percent of all wages earned will be contributed toward the cost of care and maintenance. If the monthly payment is less than $ 20.00, the contribution requirement shall be waived.

(i) The individual, or his or her representative payee, may utilize the funds from earned income, as he or she determines appropriate, however, he or she is responsible to maintain continued eligibility for the Medicaid DDD Community Care Program benefits.

Notes

N.J. Admin. Code § 10:46D-3.1

Amended by 56 N.J.R. 481(b) effective 4/1/2024