loading…
loading…
loading…
Page 10 of 18 § 10:71-4.1 Financial eligibility standards; resources policy that was no longer in effect. Even though it was then established that the policy was a term policy with no cash or surrender value that had lapsed years earlier, the agency ungenerously had refused to waive a few week delay on the submission. A.F. v. Morris Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 11409-16, 2016 N.J. AGEN LEXIS 825, Initial Decision (October 3, 2016). Social services board acted properly in requesting income verification for a deceased nursing home resident for the two month period between August 1, 2015, the date of Medicaid eligibility requested by counsel, and the date of application, which was October 22, 2015, because the governing regulations made it clear that the month of application determined resource eligibility even if one was seeking eligibility from a date two months prior to the application. P.S. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 05515-16, 2016 N.J. AGEN LEXIS 755, Initial Decision (September 9, 2016). ALJ approved of a transfer penalty imposed on the Medicaid eligibility of an ex-wife on findings that the circumstances surrounding the execution of a property settlement agreement (PSA) by the parties were such that the ex-wife did not rebut the presumption that the PSA was entered in for the purpose of making the ex-wife Medicaid eligible. Once the equity in the couple's house was included in the shared assets, the ex-wife in fact received only about 1/3 of the value of the couple's property. Though the ex-wife may have wished to provide for her former husband to remain in the community even after their divorce, establishing Medicaid eligibility for herself was the overriding factor in the determination to allocate more of the joint assets to the ex-husband so the transfer penalty imposed by DMAHS was properly approved. N.W. v. Monmouth Cnty. Div. of Social Servs., OAL DKT. NO. HMA 13129-15, 2016 N.J. AGEN LEXIS 725, Initial Decision (August 22, 2016). County social services board erred when it classified a $ 653 payment received monthly by a special needs trust for a disabled Medicaid applicant as "available income" for purposes of an eligibility determination because the applicant did not personally receive the annuity income payments, which were payable only to the trustee of the trust and were subject to the trustee's disposition. N.U. v. Morris Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 07715-16, 2016 N.J. AGEN LEXIS 710, Initial Decision (August 1, 2016). Although an ALJ was correct in determining that a Medicaid recipient had failed to rebut the presumption that the recipient had transferred her home to her son for the purpose of spending down assets so that she would be eligible for Medicaid, the ALJ's determination of the value of the property was incorrect and remand for further proceedings to properly apply governing law on the issue of value. N.D. v. DMAHS et al., OAL DKT. NO. HMA 08703, 2016 N.J. AGEN LEXIS 1172, Remand Order (July 6, 2016). Two month penalty was properly imposed on an applicant's Medicaid eligibility on account of her having transferred her two-thirds interest in certain real estate for less than market value within the look-back period. Though other family members testified to their sincerely-held belief that the applicant did not own such an interest in the transferred property, such testimony was insufficient to overcome documentary evidence demonstrating otherwise. Moreover, even if the property had been placed in trust for the applicant, that would not change the result because the applicant had already transferred her interest for less than market value. L.S. v. Somerset Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 15032-14, 2016 N.J. AGEN LEXIS 535, Initial Decision (June 27, 2016). Decision by a county board of social services that an applicant for long-term care Medicaid benefits was properly subjected to a transfer penalty on account of her uncompensated transfer of $ 51,000 was approved in part by an ALJ who concluded that the applicant had unrestricted access to the joint bank account from which the funds were withdrawn. The fact that the board did not act as promptly as might have been desired in approving the applicant's use of a Qualified Income Trust provided no basis for any relief. However, the start date for the penalty period had been incorrectly designated by the board and should have been May 1, 2015. A.D. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 02068-16, 2016 N.J. AGEN LEXIS 523, Initial Decision (June 16, 2016). Medicaid application was properly denied on findings that the applicant had excess resources. Though the applicant claimed that resources in two financial institution accounts were not "accessible" to her within the meaning of governing regulations, the evidence as to one of those accounts was to the contrary and the applicant's failure to