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Page 2 of 2 § 10:71-3.15 County social service agency responsibility and procedures; eligibility factors Notes Chapter Notes Case Notes County social services board erred when it established an eligibility date of February 1, 2015 on an application for Medicaid benefits. Although the board denied having received relevant information about real estate owned by the applicant and listed for sale prior to the August 14, 2014 application for benefits, the evidence clearly showed that all of the necessary information was provided to the board with the August 14, 2014 application and that a DRA- compliant annuity was purchased thereafter. That being so, the property should not have been considered an includable asset and the eligibility date should have been the date on which the application was made, which was August 14, 2014. M.O. v. Burlington Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 13076-15, 2017 N.J. AGEN LEXIS 836, Initial Decision (November 8, 2017). The agency's failure to comply with the regulatory deadlines for the processing of a Medicaid application notwithstanding, the applicant did not comply with proper requests for documentation concerning a special needs trust and certain insurance and annuity policies with the result that the agency could not verify the applicant's resources and properly denied the application on that basis. K.S. v. DMAHS, OAL DKT. NO. HMA 14539-16, 2017 N.J. AGEN LEXIS 705, Initial Decision (September 7, 2017). Agency's denial of an application for Medicaid nursing home benefits on the ground that agency requests for information were unfulfilled was reversed because, unbeknown to the agency, applicant's wife, who was responding to the agency's information requests, had been hospitalized as a result of a fall and spent several weeks in a rehabilitation facility. Given those unforeseen circumstances, the applicant's wife should have been allowed additional time to respond to the agency's follow-up requests. R.B. v. Burlington Cnty. Bd. of Social Servs., OAL DKT. NOS. HMA 14375-16, HMA 04295-16 (Consolidated), 2017 N.J. AGEN LEXIS 313, Initial Decision (May 15, 2017). Agency did not err in denying a Medicaid application because applicant neither supplied the requested information about resources nor requested that the agency assist her in obtaining missing documentation. E.F. v. Essex Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 09216-16, 2017 N.J. AGEN LEXIS 72, Initial Decision (February 3, 2017). DMAHS rejected an ALJ's finding that a Medicaid applicant was entitled to benefit eligibility for Medicaid Managed Long Term Services and Support as of December 1, 2015 and reinstated the agency ruling that the applicant's eligibility began on February 1, 2016 because the applicant was ineligible until the completion of pre-admission screening demonstrating that the applicant required, at a minimum, the services described in N.J.A.C. 8:85-2.2. Because the applicant did not meet that criterion until February 1, 2016, that was the proper eligibility date. D.L. v. Essex Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 7350-2016, 2016 N.J. AGEN LEXIS 1309, Final Administrative Determination (October 4, 2016). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law End of Document