loading…
loading…
loading…
Page 9 of 11 § 10:71-4.4 Excludable resources the applicant's other resources meant that she exceeded the resource limit of $ 2,000, her application was properly denied. P.J., v. DMAHS and Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 9140-2014, 2014 N.J. AGEN LEXIS 1300, Final Administrative Determination (October 28, 2014). Medicaid applicant had "access" to funds in her checking account within the meaning of governing regulations given the absence of any showing of any external factor that prevented the applicant from accessing them. D.W. v. Passaic Cnty. Bd. of Social Serv., OAL Dkt. No. HMA 15245-13, 2014 N.J. AGEN LEXIS 915, Final Administrative Determination (September 2, 2014). Initial Decision finding that an applicant for Medicaid who apparently had been declared to be incompetent many years earlier and whose parents had been appointed guardians could not access certain life insurance policies and that the value of such policies thus was not correctly included in her "resources" was reversed because there was ample evidence in the record showing that the applicant in fact had dealt with those policies including executing a change of beneficiary and taking other actions with legal consequences. P.M. v. DMAHS, OAL DKT. NO. HMA 18597-2013, 2014 N.J. AGEN LEXIS 901, Order Reversing Initial Decision (August 8, 2014). Passaic County Board of Social Services (PCBSS) incorrectly determined an applicant's Medicaid effective date pursuant to N.J.A.C. 10:71-2.3(b). Because of the applicant's dementia she was unable to place her house on the market or instruct her disabled son on what to and was in a situation prior to the appointment of a guardian, due to no fault of her own, that prevented her from making the property available and accessible to her. In addition, her property should have been excluded when counting resources to determine Medicaid eligibility under N.J.A.C. 10:71-4.4(b)6. The law excluded the house, based on the unavailability and inaccessibility of the asset at the time she entered the nursing home and applied for Medicaid and because of the legal rights of her disabled son who could reside in or sell the home, with proceeds from the sale placed in a Special Needs Trust for his care and upkeep. Because PCBSS accepted the application, processed it and determined eligibility, it should be equitably estopped from claiming the application was invalid. B.S. v. Div. of Med. Assistance and Health Serv. and Passaic Cnty. Bd. of Social Serv., OAK Dkt. No. HMA 09208-12, 2014 N.J. AGEN LEXIS 428, Initial Decision (July 23, 2014). After the Burlington County Board of Social Services (BCBSS) improperly failed to characterized a trust as an excludable resource under N.J.A.C. 10:71-4.4 and denied a Medicaid application, an administrative law judge reversed the BCBSS decision. The BCBSS provided no credible evidence to support their conclusion that the trust was revocable. On the contrary, the preponderance of the credible evidence clearly indicated that this was not a revocable trust and that the applicant had no access to these funds, through no fault of her own. E.M. v. Burlington Cnty. Bd. of Social Serv., OAL Dkt. No. HMA 363-14, 2014 N.J. AGEN LEXIS 388, Initial Decision (June 30, 2014). Determination of a county that a petitioner who was applying for Medicaid was ineligible based on excess resources was modified. The excess resource was an annuity that was purchased by the petitioner's wife with $ 208,331.39 of the couple's money. Those funds were properly viewed as "accessible" only for the two months during which the wife could have voided the annuity contract, but once the funds were nonrecoverable, the funds no longer were "accessible" under governing law. P.M. v. DMAHS and Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA_7779-2013, 2014 N.J. AGEN LEXIS 1028, Final Administrative Determination (June 26, 2014). Agency determination denying the application of a disabled adult for enrollment in the Community Care Waiver/Medicaid Only (CCW) on the ground that her resources exceeded the ceiling imposed by N.J.A.C. 10:71- 1.2(a) and N.J.A.C. 10:71-4.1 was reversed. The disabled adult owned life insurance policies, one of which had a cash surrender value of $ 2,065, and her ownership thereof meant that her resources exceeded the eligibility standard of $ 2,000. However, resources which are not accessible to an individual through no fault of his or her own are excluded per N.J.A.C. 10:71-4.4(b)6. Thus, though the cash value was "available" to the disabled adult in the sense that she had the right to liquidate the policy, the circumstances presented by these facts, which included that the adult has Down's Syndrome and had been declared incompetent by reason thereof, the adult lacked the capacity to deal with the insurance, and its value should not have been considered when evaluating the adult's resources. Once the value thereof was excluded, the adult was eligible for Medicaid as of the proposed date of