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Page 4 of 14 § 10:71-2.2 Responsibilities in the application process DMAHS Director reversed an ALJ's Initial Decision in favor of a Medicaid applicant and reinstated an agency ruling denying benefits on the ground that the applicant failed to provide the needed information prior to the date on which benefits were denied and that the determination notice issued by the agency sufficiently set out the action that the agency was taking, the rationale therefor and the statutes that supported the proposed action. D.C. v. DMAHS, OAL DKT. NO. HMA 06870-17, 2017 N.J. AGEN LEXIS 1310, Final Agency Determination (December 7, 2017). Once a Medicaid recipient was declared incompetent by reason of dementia, he in fact did not have "access" to the cash value of his life insurance policies for the purpose of resource counting and that value could not be used as a basis to terminate his benefits based on the existence of excess resources. Nor was a delay in the verification of financial information good grounds to terminate the recipient's benefits. Both of these circumstances were byproducts of a five-month delay between the filing of a verified complaint for guardianship in the Superior Court and the issuance, by that court, of an order granting the same and the additional delay occasioned by the guardian's need to obtain Letters of Guardianship and a related bond. R.P. v. Gloucester Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 05302-17, 2017 N.J. AGEN LEXIS 734, Initial Decision (September 28, 2017). Determination of county social services board denying a Medicaid application made on behalf of a disabled woman who died during the pendency of the proceedings was rejected by an ALJ on findings that the board failed to comply with the 90-day statutory time frame for decision, failed to advise the applicant's representative as to why the application was not being determined on a timely basis, allowed 570 days to elapse between the date of application and the date of denial, and otherwise failed to comply with its obligations vis-a-vis the application. D.C. v. Burlington Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 6870-17, 2017 N.J. AGEN LEXIS 727, Initial Decision (September 18, 2017). Though no exceptions were filed, the DMAHS director reversed the Initial Decision of an ALJ finding that the daughter of a Medicaid applicant who had since died had provided sufficient verification for the applicant to be considered for Medicaid benefits and that the agency should accept such documentation with an original application date and instead concluded that the credible evidence established that the daughter had failed to provide the needed information prior to the date of denial and that the agency properly concluded that it was unable to determine the applicant's income or whether her QIT was fully funded. S.A. v. Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 3094-17, 2017 N.J. AGEN LEXIS 1046, Final Agency Determination (September 8, 2017). ALJ rejected an agency determination denying Medicaid benefits to an applicant, which denial was based on the agency's finding that the applicant had failed to provide required verifications. The evidence tended to show that the applicant's representative in fact provided most of the requested documents prior to the deadline and timely requested clarification of some of the requested items, which clarification was not timely provided. Nor was the agency's claim that the documents should have been included in tabbed volumes sufficient to justify the agency's denial. S.I.K. v. Passaic Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 03882-17, 2017 N.J. AGEN LEXIS 703, Initial Decision (September 8, 2017). There was nothing in state or federal law governing the application for and grant or denial of Medicaid benefits that excused an applicant from her obligation to obtain documents needed to verify her eligibility or required the county social services board to obtain documents not available through the Asset Verification System (AVS) system. J.F. v. DMAHS et al., OAL DKT. NO. HMA 03786-17, 2017 N.J. AGEN LEXIS 1047, Final Agency Determination (August 29, 2017). Social services board acted properly in denying an application by a Medicaid applicant for Qualified Income Trust (QIT) Nursing Home Medicaid benefits based on the applicant's failure to assist the board due to her failure to provide requested documentation. Though a copy of the "Family Trust" was submitted, the schedules that were related to the Trust and were submitted to the board were blank. That meant that the applicant had failed to submit information that adequately documented the inventory of the trust. It was not the duty of the board to secure such information independently. L.A. v. Monmouth Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 6627-17, 2017 N.J. AGEN LEXIS 651, Initial Decision (August 23, 2017).