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Page 3 of 3 § 10:70-1.1 Program scope Determination by a county board of social services (CBSS) denying a petitioner's request that she be found eligible for nursing home disabled benefits per N.J.A.C. 10:70-1.1 et seq. was affirmed. CBSS took the position that ineligibility was the proper outcome because petitioner not only failed to provide all documents requested by CBSS within the 45-day period described in N.J.A.C. 10:71-2.3 but that petitioner's submission was still incomplete on December 9, 2013, which was more than four months after the 45 day period had expired and more than six months after the date of the application. Moreover, the fact was that petitioner effectively had produced little to no information until she received the denial letter on December 9, 2009 and was inspired to make a real effort to provide the documents only after the denial was received. Such facts did not establish exceptional circumstances that would justify an extension of the applicable time limits. G.G. v. Ocean Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 1127-14, AGENCY DKT. NO. 1510041726-01, 2014 N.J. AGEN LEXIS 377, Initial Decision (June 27, 2014). An Administrative Law Judge (ALJ) concluded that a county agency had acted improperly in imposing a nine- month and 17-day penalty against the Medicaid eligibility of a 100-year old woman based on the agency's claim that there were unexplained expenditures during the five-year look-back period imposed under N.J.A.C. 10:70-1.1. The evidence indicated that the woman's financial condition was dire, principally because she had spent a large amount of money in response to mailed solicitations that purportedly reflected that she had won one or more lotteries. She also apparently became convinced that she owed money on certain reverse mortgages. Though acknowledging that some unexplained expenditures remained, the ALJ found that the preponderance of the credible evidence supported the petitioner's argument that she lost funds on lottery schemes and similar scams that preyed on the elderly and that the funds were neither gifted nor transferred without value in anticipation of establishing Medicaid eligibility. F.W. v. Morris Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 13978-13, 2014 N.J. AGEN LEXIS 258, Initial Decision (May 12, 2014). Initial Decision (2006 N.J. AGEN LEXIS 980) adopted, which found that although the term "gross income" is not specifically defined for the Medically Needy program found at N.J.A.C. 10:70-1.1 et seq., the Medicaid Only program does contain definitions for earned and unearned income under N.J.A.C. 10:71-5.1(b) and both N.J.A.C. 10:71-5.4 and N.J.A.C. 10:71-5.6 make reference to gross income; thus, while not a paradigm of clarity, the regulations imply that gross income is the proper figure to use in making eligibility determinations for the Medically Needy program as well as the Medicaid Only program. J.O. v. DMAHS, OAL Dkt. No. HMA 4407-06, 2006 N.J. AGEN LEXIS 935, Final Decision (October 24, 2006). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law End of Document