loading…
loading…
loading…
Page 3 of 4 § 10:72-2.3 Verification requirements certain pension information requested by the agency was not available to her, and that her status as POA for her mother had terminated upon the latter's death. S.A. v. Union Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 03094-17, 2017 N.J. AGEN LEXIS 500, Initial Decision (July 6, 2017). Agency should not have denied a Medicaid application on a finding that required financial verifications were not provided but should have granted additional time to the applicant to obtain the requested documents because the applicant's representative made ongoing concerted efforts to obtain the requested documents and had promptly advised the agency of the difficulties that were being encountered by the representative in trying to obtain documents from a financial institution that had been acquired by another institution. W.S. v. DMAHS et al., OAL DKT. NO. HMA 11145-16, 2016 N.J. AGEN LEXIS 866, Initial Decision (October 21, 2016). Eligibility penalty was properly imposed on an elderly man's application for skilled nursing home Medicaid benefits based on $ 247,104 in transfers during the look-back period. Though the applicant's representative claimed that the bulk of those payments were made to compensate a woman who provided care to the applicant, the record did not include a caregiver agreement or like contract for such services nor were there invoices proving that some of the funds were used to make repairs to the residence. It thus was properly presumed that they were transfers for less than fair market value for the purpose of establishing Medicaid eligibility. A.M. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 17835-2015, 2016 N.J. AGEN LEXIS 636, Final Administrative Determination (May 26, 2016). Eligibility penalty was properly imposed on an elderly man's application for skilled nursing home Medicaid benefits based on $ 247,104 in transfers during the look-back period. Though the applicant's representative claimed that the bulk of those payments was made to compensate a woman who provided care to the applicant, there was no evidence whatever that the recipient of those payments actually rendered services to the applicant and it thus was properly presumed that they were transfers for less than fair market value for the purpose of establishing Medicaid eligibility. A.M. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 17835-2015, 2016 N.J. AGEN LEXIS 200, Initial Decision (April 15, 2016). Because a county board of social services was entitled to establish a cut-off date for submission, by an applicant, of information requested by the board and needed to determine whether the applicant was eligible for Medicaid, the determination that the applicant had failed to submit needed materials was properly affirmed. While a county board had the option to afford additional time to an applicant, it nonetheless was entitled to determine when sufficient time was allowed and to make a decision based on the information in its possession on the deadline. N.V. v. DMAHS and Gloucester Cnty. Bd. of Social Servs.,OAL DKT. NO. HMA 01201-16, 2016 N.J. AGEN LEXIS 140, Initial Decision (March 17, 2016). Denial of an applicant's request for Medicaid benefits was sustained on review because the applicant admittedly refused to respond to the agency's requests for verification from the applicant's daughter to the effect that the daughter was paying some part of the applicant's rent and verification from the applicant's son to the effect, inter alia, that he resided with his mother. Though the applicant ostensibly had documents that provided the requested verifications, she refused to produce them until the County Board of Social Services allowed her to review her file. E.A. v. Hudson Cnty. Bd. of Social Servs., OAL DKT. NO HMA 12173-15, 2015 N.J. AGEN LEXIS 692, Initial Decision (October 28, 2015). ALJ concluded that a board of social services should not have imposed a transfer penalty on the Medicaid eligibility of an applicant based on expenditures equaling $ 114,917 because the applicant's family established that all such funds actually went to pay caregivers who were providing around-the-clock care to the applicant in her home, thereby rebutting the presumption that such funds were transferred for less than fair value in order to qualify the applicant for Medicaid. M.G. v. Camden Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 07800-15 (on remand HMA 13067-14), 2015 N.J. AGEN LEXIS 691, Initial Decision (October 5, 2015). Medicaid eligibility of a recipient was properly terminated on a finding that an absent parent of the recipient's younger minor child in fact lived with the recipient notwithstanding the recipient's denial that the absent parent in