Page 118

Page 11 of 18 § 10:71-4.1 Financial eligibility standards; resources provide documentation relating to the other account meant that there was insufficient evidence to overcome the presumption that the funds in the second account also were accessible. F.J. v. DMAHS et al., OAL DKT. NO, HMA 9451-2015, 2016 N.J. AGEN LEXIS 896, Final Administrative Determination (June 10, 2016). Transfer penalty was properly imposed on a Medicaid applicant based on a transfer of real property to relatives during the look-back period because a claim that the applicant was mentally ill and thus financially and physically unable to manage the property at the time of the transfer was unsubstantiated. M.L. v. DMAHS and Atlantic Cnty., Bd. of Social Servs., OAL DKT. NO. HMA 00570-16, 2016 N.J. AGEN LEXIS 352, Initial Decision (May 24, 2016). Agency rejected an ALJ's recommendation that a Medicaid denial be reversed and sustained the initial agency ruling on findings that the applicant's son, who was acting for his mother, failed to provide the agency with adequate information in the first instance explaining the disposition of the applicant's assets, including the hundreds of thousands of dollars that had been drained from the applicant's accounts. Given the inadequacy of the information provided to the agency, the applicant was per se ineligible for benefits. A.F. v. Hudson Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 02986-15, 2016 N.J. AGEN LEXIS 603, Final Decision (May 11, 2016). Though the income of an applicant for Medicaid fluctuated seasonally, his income in the month in which he and his wife sought recertification of eligibility exceeded the ceiling and afforded good grounds to deny the application. J.M. v. DMAHS, OAL DKT. NO. HMA 17572-15, 2016 N.J. AGEN LEXIS 143, Initial Decision (March 21, 2016). Sufficient evidence supported the determination of a county board of social services that the funds in a bank account in the names of the applicant and her daughter were a resource of the applicant and were properly counted in determining the applicant's resources for the purposes of qualifying for participation in the Medicaid Only Program. Since those funds well exceeded the ceiling for eligibility, the applicant was properly found to be ineligible. M.H. v. Mercer Cnty., Bd. of Social Servs., OAL DKT. NO. HMA 16444-15, 2016 N.J. AGEN LEXIS 142, Initial Decision (March 17, 2016). Determination of a county board of social services that an elderly woman's countable resources exceeded the eligibility resource limit, though originally sustained by an ALJ, was approved after remand and further proceedings on findings that the woman's access to an account that held $ 5,658 at the time of the application was unrestricted. Though the parties had stipulated that the account at issue was jointly held by the woman and her daughter, the ALJ noted that the woman did not submit any documentation proving that her access to those funds in fact was restricted and that there was evidence suggesting that each account owner could act independently with regard to transactions therein. F.J. v. Camden Bd. of Social Servs., OAL DKT. NO. HMA 9451-15 (On Remand HMA 15125- 14), 2016 N.J. AGEN LEXIS 119, Decision on Remand (March 14, 2016). Board of social services erred when it denied Medicaid benefits to an applicant who had suffered from dementia for several years on the grounds that she had failed to provide the information and documents requested by the agency and because her "available" resources exceeded the maximum allowable under regulations. The evidence made it quite clear that the applicant did not and could not have participated in the liquidation of her personal and marital assets and that the assets at issue were neither "accessible" nor "countable" in relation to the applicant. A.F. v. Hudson Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 02986-15, 2016 N.J. AGEN LEXIS 63, Initial Decision (February 12, 2016). Pension and disability benefits paid by a qualified pension plan that was governed by ERISA and that were deposited into a bona fide special needs trust established per 42 U.S.C.S. § 1396p(d)(4)(A) and governing state law were "available" to the disabled payee for purposes of determining her Medicaid eligibility because, as a matter of law, such payments could not be assigned to the special needs trust. That being so, such payments constituted "available income" that was countable in determining the payee's income for the purpose of eligibility for the Medically Needy Program. P.R. v. DMAHS and Hunterdon Cnty. Div. of Social Servs., OAL DKT. NO. HMA 05481- 12, 2015 N.J. AGEN LEXIS 766, Initial Decision (December 15, 2015). ALJ rejected the determination of a county social services board that an applicant was entitled to Medicaid benefit eligibility as of May 2015 and reset the eligibility date as January 2015 because the applicant applied for benefits in