www.OGMHognj.com
InfoSheet SubPage - Medicaid and SSI Resource Exclusions

Ocean Grove Memorial Home
118 Main Avenue, Ocean Grove, New Jersey 07756

Thomas J. Saragusa, Manager
N. J. License No. 4036

VOICE 732-775-0434 - - OGMHognj@aol.com

NOTE: This page is under construction! All of this data was accurate at one time but times (and programs) change. This data is being reevaluated under current statutes and regulations. Names and phone numbers may no longer be accurate but the addresses probably are. This page is updated as more accurate information is verified.

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Details Regarding Eligibility Criteria for SSI and Medicaid

“Resources” and assets excluded from being counted as resources

The assets of applicants for Supplemental Security Income and/or N. J. Medicaid benefits are categorized so they may be evaluated for eligibility determinations. The following criteria represent maximum amounts that applicants for SSI or Work First New Jersey (WFNJ, formerly the Monmouth County Community Care Program for the Elderly and Disabled CCPED) are allowed to continue to own or receive and remain eligible to receive benefits.

• 1. Gross Monthly Income may not exceed $1,221.00 for WFNJ recipients. SSI recipients are limited to $453.25 if they receive no Social Security payment and up to $473.25 if they do.

• 2. Personal Belongings - Items such as clothing, furnishings and other personal items are allowed to be owned.
  Generally no restrictions apply to these items, however, “value limiting” restrictions may apply to items of substantial value such as jewelry, equipment, an automobile and/or a dwelling.

• 3. Non-excluded unrestricted limited cash funds or personal Resources may not exceed $2,000.00.
  This asset is "unrestricted" in that funds may be spent for any purpose of the owner but it is "limited" in that the maximum value may not exceed $2,000.00. This category represents all spendable assets including the Cash Value of life insurance policies if the total face value of all owned policies exceeds $1,500.00. If any other asset is easily converted to cash and is not specifically “excluded from being counted” in one of the following categories, it also is assumed to be included in this category. The total value of the following resources will be counted toward the resource limit: the cash value of stock certificates, mutual funds, certificates of deposit, money market account, Christmas Club accounts, checking accounts, savings accounts, IRA accounts, owned mortgages, cash, valuables in a safe deposit box and other assets that can easily be converted to spendable cash to the extent that they are owned by the recipient. Special care should be taken when administering this fund because eligibility depends on this fund never exceeding the maximum allowed as of "the first moment of the first minute of every subsequent month."
  
  N.B. In this document, the word “excluded” means “excluded from being counted in the category of personal resources that are available and spendable by the recipient” (as above)...being “excluded” means that the recipient may continue to own the asset.

• 4. The total value of Burial Space owned by the recipient is excluded from being counted as a “resource.”
  An applicant may own "repositories which are customarily and traditionally used for the remains of deceased persons." Such repositories are further specifically defined to include but are not limited to a casket, a burial "vault" or an urn for cremated remains, a conventional gravespace, a crypt in a mausoleum or a niche in a columbarium, the charge to prepare that space for actual use and a stone grave marker or a bronze memorial plaque or the final engraving of an existing memor- ial or marker.
  There is no dollar limitation currently placed on any of these items. The Burial Space Exclusion Test is satisfied if the specific items claimed are wholly owned by the applicant for his burial (or that of his spouse or immediate family) or that the future provision of such space is properly contracted for. In the case of a conventional grave, a crypt or a niche, a copy of the deed from the cemetery or mausoleum is sufficient documentation. In the case of other repositories such as a casket, a burial receptacle or an urn, a bill of sale from the manufacturer or, more commonly, a statement from a funeral director that payment has been placed in trust, is sufficient documentation that valid ownership exists.
  “It was the judgment of Congress that persons should not have to choose between lifesaving welfare assistance and giving up their plan for the disposition of their bodily remains.”

• 5. The total value of an Irrevocable Funeral Trust is excluded from being counted as a “resource.”
  There is no dollar limitation placed on an irrevocable prepaid funeral trust, however, certain other restrictions apply. It is important to understand that a crime in the fourth degree is committed if assets are fraudulently placed in an irrevocable funeral trust. All values must be related to a bonafide written funeral contract for actual services and merchandise to be provided at the death of the Intended Funeral Recipient. If owned, an irrevocable funeral trust is the first asset excluded and it’s value will affect the following asset if they are owned by the recipient.

• 6a. The total value of owned Burial Funds is excluded from being counted as a “resource” only if:

  • They are held separately from all other funds.
    and if

  • The total value of the Burial Funds does not exceed $1,500.00 plus accrued interest.
    This type of fund is limited to $1,500.00 as an initial deposit and excluded interest may accrue (only) if it is left in the account. Such an account may be documented by the funeral home with which the contract is made. Typically, a contract includes the funeral home’s services, use of facilities, livery and equipment and non-excluded merchandise. It is not required that the total cost of that contract be limited to $1,500.00...it is required, however, that the total cash value available to the applicant if it is a revocable trust be limited to $1,500.00 (plus accrued interest).

• 6b. The total value of owned Life Insurance Policies is excluded from being counted as a “resource” only if:

  • 1. The FACE VALUE of the policy is equal to or below $1,500.00 and the policy is being held for funeral purposes.
    or

  • 2. If the FACE VALUE is greater than $1,500.00, the Face Value is excluded from being counted as a “resource,” however, the CASH VALUE is counted as a resource. Because it has no cash value, Term Life Insurance is ignored for the purposes of eligibility.

  EXCEPT . . . the limit of $1,500.00 is a cumulative limit for both the owned excluded Life Insurance and the owned excluded “Burial Funds” and the $1,500.00 limit for each shall be reduced dollar for dollar by the other if both are owned, and additionally, the individual $1,500.00 limit for “Burial Funds” shall be reduced dollar for dollar by the value of an irrevocable funeral trust, if one is owned.

In other words:

• If a recipient has granted an Irrevocable Funeral Trust any excluded Burial Funds must be reduced dollar for dollar by the value of the irrevocable trust.

• If a recipient owns both excluded Life Insurance and excluded Burial Funds, the cumulative total of both values can’t exceed $1,500.00. An Irrevocable Funeral Trust fund has no effect on the ownership of excluded Life Insurance.
  

For Verification:

To verify this information for New Jersey Medicaid Programs, you may contact the Supervisor of Intake at your county Division of Social Services office. In Monmouth County, the Supervisor of Intake is Mrs. Marie Drutz - 431-6315..her assistant is Mrs. Metzger. The address is:

Monmouth County Board of Social Services
P. O. Box 3000
Freehold, N. J. 07728

If that agency does not confirm these statements, your local county Field Representative from the New Jersey Department of Human Services should be contacted by writing to:

(Your County) Field Representative
N. J. Department of Human Services - Alan J. Gibbs, Commissioner
Division of Economic Assistance - Mrs. Marion E. Reitz, Director
Capitol Place One
222 South Warren Street
Trenton, N. J. 08625

or by writing to: Mrs. Marion E. Reitz, c/o Division of Economic Assistance

or to: Alan J. Gibbs...directly.

For verification for Supplemental Security Income Programs, you may contact any SSI Claims Representative at the local office of the federal Social Security Administration. In the Asbury Park area, a claims representative may be reached at 774-9106. The address is:

Social Security Administration
645 Neptune Boulevard
Neptune, N. J. 07753

Ms. Linda Bieri is the SSI Program Coordinator

...or the Chief Administrator in charge of that Social Security Administration agency.

Another source of information may include:

Saul M. Kilstein, Director of the Department of Medical Assistance and Health Services (609) 588-2600

When you apply for coverage under any of these programs, please gather as many of each of these individual items as are readily available and provide them to the Social Worker:

• 1. Recipients must be 65 years of age or older or must be permanently and totally disabled. Verification of the age of the applicant: Birth Certificate - Baptismal Certificate - Drivers License - Life Insurance Policy if it indicates an age or birthday - Notice of Age from the Social Security Administration School Records showing age - Hospital Records showing age.

• 2. Verification of citizenship of the applicant: Birth Certificate - Notice from the Social Security Administration - a Voter’s Registration Card and IF NOT BORN IN THE UNITED STATES - Naturalization Certificate - Passport - Alien Green Card.

• 3. Proof of current income of the applicant: Social Security Form SSA 2458 - Savings Account Books Checking Account Statements if deposits are deposited automatically or copies of checks - If the applicant’s income includes private pensions - Pension stubs or a letter from the company explaining the applicant’s benefits - any other accurate information about the applicant’s income.

• 4. Verification of the resources or assets currently owned by the applicant: All banking statements including information about Certificates of Deposit - Owned Stocks and Bonds - Christmas Club Books and any other accurate information that reflects current ownership of assets.

• 5. Information about life insurance policies currently owned by the applicant: The policy itself or a photocopy of that part of the policy that indicates the Name of the Insured, the Face Value, the Date of Issue, the Policy Number and the Name of the Company. If the combined total of the face value of all policies is greater than $1,500.00, a letter from the home office of the Life Insurance Company stating the current Cash Value will be needed. Term Life Insurance should be listed but will not be considered in the eligibility determinations.

• 6. Information about real property currently owned by the applicant: Deeds, Title certificates or tax records for real property owned either individually or jointly by the applicant.

• 7. Information about automobiles owned by the applicant : Title certificate of all vehicles currently owned by the applicant.

• 8. Documentation of prepaid funeral accounts, trusts, or other types of prepaid assets: Copies of revocable funeral contracts - Irrevocable Prepaid Funeral Trusts - Burial Space contracts, titles and deeds.

In addition to the items noted above, please be prepared to present:

• Social Security Card or other accurate documentation of the applicant’s Social Security Number or Taxpayer Identification Number

• Medicare Card or other accurate documentation

• Health Insurance Card or other accurate documentation of the applicant’s Health Insurance coverage including proof of premiums having been paid, e.g., canceled checks, receipts, money order stub or premium notice stubs.

Medicaid will deduct the amount of private health insurance premiums from income payable to the nursing home. The recipient will also be allowed to keep $35.00 for personal expenses each month. That amount will also be deducted from income payable to the nursing home.
(N. B. Such various cash amounts will accrue to and be counted as additional countable resources if they are not spent each month. Care must be taken to see that the recipient does not lose eligibility because this amount is not spent monthly and accumulates in the recipients personal RESOURCES account.)

The Social Security Administration administers the federal Supplemental Security Income Program.

Linda Bieri 774-2855 Program Coordinator

(any) SSI Claims Representative 774-9106

Monmouth County Division of Social Services administers the N. J. Medicaid Program in Monmouth County.

Stephen Shapiro 431-6329 - Program Coordinator

or try Jane Stout 431-6380

Regarding At-Need Funeral Expenses

Neither the SSI nor the Medicaid programs (themselves) provide for payment for funeral expenses but several county Division of Social Service programs may.

Regarding death or funeral payments...$1970 + $460 (+ $1570 contributable) ...available from Monmouth County Division of Social Services.

Recipients of Medicaid who may be deemed eligible for death or funeral benefits include:

• CCPED recipients (Community Care Program for the Elderly and Disabled)

• SSI Only recipients

A phone call to the MCDSS during regular business hours is the ONLY sure method of determining a recipient’s eligibiltiy for death payments.

See the InfoSheet on MCDSS Funeral Payments.

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