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Page 2 of 3 § 10:71-5.2 Determination of countable income Notes Chapter Notes Case Notes Because a Medicaid applicant's countable income exceeded the applicable income limit, the ALJ's determination that the application for Medicaid benefits was properly denied was correct. P.P. v. DMAHS et al., OAL DKT. NO. HMA 4563-2020, 2020 N.J. AGEN LEXIS 113, Final Agency Determination (July 26, 2020). County social services board properly determined that an applicant for Medicaid Only benefits was both over- income and over-resourced in November 2015 and was over-income in December 2015 because errors in the manner in which the applicant's Qualified Income Trust was set up were not corrected until December 2015 and because the applicant received a retroactive pension payment in December 2015. B.S. v. Atlantic Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 07474-2016; OAL DKT NO. HMA 19142-16 (Consolidated), 2017 N.J. AGEN LEXIS 539, Initial Decision (July 7, 2017). DMAHS director reversed an Initial Decision and remanded for additional proceedings because the county's determination of which of an applicant's checks representing separate pension entitlements needed to be deposited into a QIT was incorrect. Checks drawn on the "Second Injury Fund" were issued on every other Friday, and that meant that there would be months which would have five Fridays and the applicant might receive three checks. The county had to determine the deposit dates of such checks in order to determine the applicant's eligibility date as well as his entitlement to retroactive benefits. J.S. v. DMAHS, OAL DKT. NO. HMA 0046-2017, 2017 N.J. AGEN LEXIS 1121, Order Reversing and Remanding (May 3, 2017). Community spouse (applicant) who represented to a county temporary support office that the applicant's son was paying the applicant's housing expenses was not entitled to any relief from his payment obligations. Though the applicant originally advised the agency that his son was paying his expenses, presumably as a gift, after consulting a different elder law attorney, the applicant asserted that the son was "lending" the funds to the applicant. On these facts, which included the applicant's submission of a promissory note that appeared to have been backdated, the applicant was not entitled to relief on his claim that the funds were a loan or that the agency should have counseled the applicant from the outset that characterizing the son's funds as a "loan" would be financially advantageous. E.B. v. Morris Cnty. Office of Temporary Assistance, OAL DKT. NO. HMA 14388-16, 2017 N.J. AGEN LEXIS 94, Initial Decision (February 10, 2017). County social services board properly determined that a Medicaid recipient had been ineligible for benefits and thus should be required to repay those benefits. The fact that the board had ignored important information provided by the recipient was of no consequence because equitable estoppel will not lie against the government. N.K. v. Mercer Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 17758-16, 2017 N.J. AGEN LEXIS 77, Initial Decision (February 3, 2017). Medicaid applicant won ruling that he was entitled to benefits retroactive to the date of his application for same. Benefits had been denied because the county social services board erroneously believed that the applicant was required to place his Social Security benefits in the QIT into which his pension benefits were deposited. Because the issue relative to the Social Security benefits was the only bar to eligibility, benefits should have been awarded retroactive to the date of the application. K.B. v. Middlesex Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 09839- 16; OAL DKT NO. HMA 17985-16 (Consolidated), 2017 N.J. AGEN LEXIS 75, Initial Decision (February 3, 2017). Medicaid applicant was entitled to benefit eligibility for Medicaid Managed Long Term Services and Support as of December 1, 2015 because but for the delay caused by the referral, by a county board of social services, to the