G.C. VS. DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND OCEAN COUNTY BOARD OF SOCIAL SERVICES E.M. VS. DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES AND ESSEX COUNTY BOARD OF SOCIAL SERVICES (DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES

Appellants filed for benefits under New Jersey's Medicaid — Aged, Blind and Disabled (ABD) program. Both were disabled and lived with other family members; each applicant's total "countable income" was below the federal poverty level (FPL) for a family of their size, but each applicant's individual Social Security Disability benefits exceeded the FPL for a family of one. The Department of Human Services, Division of Medical Assistance and Health Services (the Division) applied N.J.A.C. 10:72-4.4(d)(1), which stated that an applicant was ineligible if his or her "countable income . . . exceed[ed] the poverty income guideline for one person[.]" The Division denied the applications.

The court held that the regulation did not violate the federal Medicaid statute, Title XIX of the Social Security Act, but did violate New Jersey's Medicaid statute, N.J.S.A. 30:4D-1 to -19.5, which defines a "qualified applicant" as, among other things, a disabled individual "whose income does not exceed 100% of the [FPL], adjusted for family size," N.J.S.A. 30:4D-3(i)(11), and defines FPL as "the official poverty level based on family size[.]" N.J.S.A. 30:4D-3(p).