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Page 2 of 2 § 10:71-3.1 General provisions Social service agency failed to carry out its assigned responsibilities when it failed to advise the representatives of a Medicaid applicant that there were documents that had been requested by the agency but had not been supplied. That is, the agency had a responsibility to sufficiently communicate with the applicant to explain why previous submissions were insufficient. J.D. v. Essex Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 03198-17, 2017 N.J. AGEN LEXIS 398, Initial Decision (June 20, 2017). Failure on the part of an applicant for Medicaid only to submit verifications requested by a county social services board afforded grounds to deny the application because there was no evidence that the applicant or her representative made any effort to obtain the requested verifications or that they were unavailable. It was not necessary for the agency to show that the applicant or her representative had refused to obtain the information or had refused to allow the board to obtain it. To be sure, the applicant's failure to respond to the request for verifications in any manner meant that the agency had no knowledge as to whether the applicant was in the process of obtaining the verifications, required assistance in doing so or was simply refusing to cooperate. G.C. v. Bergen Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 08504-15, 2015 N.J. AGEN LEXIS 706, Initial Decision (September 22, 2015). When an applicant did not provide sufficient verification documentation for the Union County Board of Social Services to consider her application as required by N.J.A.C. 10:71-2.2(e)1 and N.J.A.C. 10:71-3.1(b), she could not be considered eligible for Medicaid benefits. The Board notified the applicant by letter on at least two occasions of the verification documentation that was needed to establish her eligibility, but she failed to prove the entire PA-5 report. N.R. v. Union Cnty. Bd. of Social Serv., OAL DKT. No. HMA 07734-14, 2014 N.J. AGEN LEXIS 449, Initial Decision (July 30, 2014). Administrative law judge reversed the Union County Board of Social Services' determination that an applicant was ineligible for Medicaid benefits. The applicant suffered from advanced Alzheimer's disease, and his son, on behalf of the applicant under N.J.A.C. 10:71-2.5(c)1, truthfully stated that he did not have any information about the source of four deposits as reflected in a submission of two years of bank statements. The application, as submitted and explained to the best of his ability and knowledge by his son, met the prudent test of credibility pursuant to N.J.A.C. 10:71-3.1(b). S.Q. v. Union Cnty. Bd. of Social Serv., OAL Dkt. No. HMA 04202-14, 2014 N.J. AGEN LEXIS 419, Initial Decision (July 21, 2014). An Administrative Law Judge (ALJ) concluded that a county board of social services acted properly when it denied an application for Medicaid eligibility made by an applicant on a finding that the applicant had failed to provide the required verification. The applicant admitted that there were several outstanding requests for documents to which she had not responded. Because the board was required by N.J.A.C. 10:72-2.3(a) and N.J.A.C. 10:71-2.9 to verify all factors related to eligibility, including sources of income and resources, the applicant's conceded failure to comply with those requests per N.J.A.C. 10:71-2.2(e)1 and N.J.A.C. 10:71-3.1(b) to provide the requested items foreclosed a determination that she was eligible for Medicaid. M.D. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 1459-14, AGENCY DKT. NO. 410052818-01, 2014 N.J. AGEN LEXIS 273, Initial Decision (May 22, 2014). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law End of Document