By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Medicaid Attorney
The maximum monthly benefits for SSI are as follows, per SSA Publication 05-11148:
Note that this is a maximum, and SSI will pay less if you have other sources of income, paying up to the maximum monthly payment amount.
Like Medicaid, the SSA has a lookback period for transfers of assets for less than fair market value. The lookback period is shorter than Medicaid’s, only 36 months from the date of filing for SSI per SI 01150.110. There are exceptions to this lookback period. They include transfers to special needs trusts, certain home transfers (including the caregiver exception), and transfers to spouses and blind or disabled children. So the payment to the son would not be part of the lookback, but the gifts to the grandsons could be if made within the past three years.
For the Medically Needy program in New Jersey, transfers of resources follow the transfer rules under the Medicaid Only program, N.J.A.C. 10:71-4.10 §10:70-5.4. The Medicaid Only program does not have a similar regulation, only noting that “[a]ged, blind and disabled persons who are living in the community and meet the requirements of the SSI program may receive Medicaid Only” while those who do not receive SSI because of income are eligible for Medicaid Only. §10:71-1.3. Interestingly, the Department of Human Services advertises, those who receive SSI “will automatically receive New Jersey Medicaid.”
If the applicant applies for SSI or has an SSI application pending, he or she cannot apply for Medicaid Only. §10:71-2.4. So the best advice to give is to wait until SSI goes through, and then apply for Medicaid Only claiming it is automatic if receiving SSI.
According to the Medicaid Eligibility Manual, an income break-even point is defined as the amount of earned and unearned income an individual can have so that their countable income equals the applicable Federal Benefit Rate (FBR). If you know what the FBR is, multiply that number by 2 and add 85 to get your monthly earned income break-even point. For the unearned break-even point, add 20 to the FBR. Essentially, If your income is at or above this break-even point, you don’t receive SSI. So whatever is earned monthly needs to stay below the earned or unearned thresholds, depending on the type of income.
There is a penalty period. To calculate it, the first thing you do is determine the amount of the value that is transferred for less than fair market value. Divide that number by the federal benefit rate plus any state supplementary payment ($1,125.36 if you are doing the application as the Setyas living alone). Round that number to two decimal places and then round that number down to the nearest whole number, and that is the number of months of ineligibility.
Annuity income is considered unearned income, and would offset the SSI benefit dollar for dollar. So if the annuity monthly payment is above $1,125.36, there’s going to be a problem getting SSI. Are you using the couple payment of $1,125.36? It would come out to 53 months. But one thing I failed to mention is that there is a maximum penalty period of 36 months regardless of the uncompensated value of the assets transferred per SI 01150.110. So the penalty is 36 months.
To discuss your NJ Medicaid & SSI matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at firstname.lastname@example.org. Please ask us about our video conferencing consultations if you are unable to come to our office.