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Page 5 of 12 § 10:71-2.3 Policy and procedure on prompt disposition Agency's denial of a Medicaid application based on the applicant's failure to provide requested information was reversed because the applicant had made many attempts to obtain them. The agency, though required to assist the applicant, in fact had made no effort to assist by utilizing either AVS or PARIS and thus could not properly deny the application based on missing information. Moreover, the resulting delay was beyond the applicant's control and could not be used as a basis for denial. C.F.J. v. Hudson Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 06589-16 (Remand of HMA 04859-14), 2017 N.J. AGEN LEXIS 50, Initial Decision (January 31, 2017). Original denial of Medicaid application was proper despite the fact that the applicant belatedly provided requested documentation because the applicant's failure to timely provide such verifications that led to the denial. It was not the agency's duty to organize and summarize raw data in the form of deposit slips or checking-account registers to determine dates of deposits and expenses paid by the applicant and/or family members in order to determine eligibility. V.W. v. DMAHS, OAL DKT. NO. HMA 12941-16, 2017 N.J. AGEN LEXIS 52, Initial Decision (January 27, 2017). Medicaid applicant won retroactive eligibility date because the social services agency responsible for acting on his application failed to timely move the case through the approval process, failed to give the applicant required notifications, failed to assist the applicant and failed to independently verify the value of resources. The overall failure on the part of the agency justified a retroactive date. W.M. v. Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 11651-16, 2017 N.J. AGEN LEXIS 27, Initial Decision (January 18, 2017). Agency rejected a Medicaid applicant's exceptions to denial of benefits that was based on the failure by applicant and/or her designated, authorized representative to provide information on certain insurance policies. Although that information in fact was provided more than a month after the deadline, there was nothing in the record to demonstrate they either asked for or that there were exceptional circumstances warranting additional time to provide the requested verifications. J.B. v. DMAHS, OAL DKT. NO. HMA 9587-2016, 2016 N.J. AGEN LEXIS 1374, Final Administrative Determination (December 15, 2016). Failure on the part of the representative for a nursing home resident to submit required documentation despite the issuance of numerous extensions of the deadline afforded grounds for a denial of Medicaid eligibility. A.D. v. Cape May Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 10418-16, 2016 N.J. AGEN LEXIS 1236, Initial Decision (December 8, 2016). County social services board did not comply with its obligations to process a Medicaid application made by an institutionalized man within 45 days nor did it comply with its obligation to provide a reason for the delay. That said, the board's conduct did not justify an exception from the rule that the date of funding of a Qualified Income Trust (QIT) was determinative of the month of Medicaid eligibility, and the determination on that issue was properly approved. J.E. v. Passaic Cnty., Bd. of Social Servs., OAL DKT. NO. HMA 10553-2016, 2016 N.J. AGEN LEXIS 1010, Initial Decision (December 5, 2016). Though the ALJ recognized that employee of a county social services board had mishandled the Medicaid application made by a husband on behalf of his institutionalized wife, the ALJ lacked the power to provide an "equitable" remedy because the wife was not Medicaid-eligible until the spend-down was completed. However, the ALJ encouraged the Commissioner to exercise any discretion possessed by the Commissioner's office in order to address the seemingly unfair result. A.S. v. DMAHS and Monmouth Cnty. Div. of Social Servs., OAL DKT. NO. HMA 13504-16, 2016 N.J. AGEN LEXIS 1015, Initial Decision (November 4, 2016). Though the agency failed to promptly process an application for Medicaid Only nursing home benefits and failed to advise the applicant of the reason for delay, the failure of the agency to advise the applicant of what needed to occur for eligibility to be determined was not grounds for an eligibility date that was earlier than that granted by the agency because the applicant was not resource-eligible earlier than the date awarded. W.H. v. Monmouth Cnty. Div. of Social Servs., OAL DKT. NO. HMA 10917-16, 2016 N.J. AGEN LEXIS 862, Initial Decision (October 19, 2016).