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Page 3 of 4 § 10:72-4.5 Resource eligibility Chapter Notes Case Notes Agency was wrong to include, in a married couple's resources, assets that in fact were transferred to a valid, irrevocable trust prior to the commencement of the 60-month Medicaid eligibility look-back period because they were "unavailable" to the couple within the meaning of current law. C.F. v. Hudson Cnty. Dep't of Family Servs., OAL DKT. NO. HMA 11517-17, 2017 N.J. AGEN LEXIS 1314, Final Agency Determination (December 20, 2017). Medicaid recipient who failed to report income the receipt of which would have rendered her ineligible for benefits was properly required to repay the $ 8687 in benefits received during the period of ineligibility because her only defense to the claim was that she was "in a rush" when she reviewed the application and thus missed the section requiring income to be reported. T.S. v. Mercer Cnty. Bd. of Social Servs., OAL DKT. NO. HMA 07970-17, 2017 N.J. AGEN LEXIS 893, Initial Decision (December 18, 2017). Medicaid application made on behalf of a married couple should not have been denied on the ground of excess resources. The resources that the agency deemed to be "excess" in fact were transferred to a valid, irrevocable trust prior to the commencement of the 60-month eligibility look-back period and thus were "unavailable" to the couple within the meaning of governing regulations. C.F. v. Hudson Cnty. Dep't of Family Servs., OAL DKT. NO. HMA 11517-17, 2017 N.J. AGEN LEXIS 824, Initial Decision (November 9, 2017). Recipient was ineligible for Medicaid and was subject to recoupment because her resources exceeded the resource limit of $ 4000 under N.J.A.C. 10:72-4.5(b). She sold real property for $ 196,006 but did not report this transaction to the Bergen County Board of Social Services until specifically asked for the information. There was also discussion about the unreported proceeds of a life insurance policy. I.B. v. Bergen Cnty. Bd. of Social Serv., OAL DKT. NO. HMA 09753-14, 2014 N.J. AGEN LEXIS 519, Initial Decision (August 28, 2014). An Administrative Law Judge (ALJ) concluded that the Bergen County Board of Social Services erred when, relying on N.J.A.C. 10:72-4.5(b)(3), it denied a Medicaid application filed by an elderly husband (Husband) and imposed a transfer penalty of 17 months and 20 days, making Husband's eligibility date September 21, 2014, based on its finding that the assets represented by three certificate of deposit (CDs) accounts titled to his wife (Wife) and Wife's sister (Sister) constituted resources within the meaning of N.J.A.C. 10:71-4.6 that were "available" to Husband within the meaning of N.J.A.C. 10:71-4.1(c) and could be converted to cash and used for the Husband's support and maintenance. Wife and Sister's submission on that issue, which included a statement from the financial institution where the accounts were held, established that the funds used to obtain the CDs were owned in toto by Sister, who was elderly, had no children, and lived alone; and that Sister's intention, in titling the accounts as she did, was to assure that Wife would have access to the funds in the event that Sister became incapacitated or to pay for her funeral expenses. Because the submission met the standards in N.J.A.C. 10:71-4.10( o)(3) and established that the funds were not a resource of Husband, the ALJ concluded that there was no basis for the imposition of a transfer penalty. W.Z. v. Bergen Cnty. Bd. of Soc. Servs., OAL Dkt. No. HMA 16767-13, AGENCY Dkt. No. 021016511201, 2014 N.J. AGEN LEXIS 99, Initial Decision (February 7, 2014). Supplemental Security Income (SSI) rules instruct that only payments to an individual because of his or her status as a victim of Nazi persecution are exempt for purposes of Medicaid eligibility, and there is no extension of this exemption to heirs; thus, an applicant for Medicaid Only nursing home benefits was not entitled to exclusion of a lump sum paid to the applicant and his sister under German Property Law for real property their grandparents owned in Berlin during the Nazi regime. H.J. v. DMAHS, OAL Dkt. No. HMA 4861-07, 2008 N.J. AGEN LEXIS 275, Final Decision (February 19, 2008). NEW JERSEY ADMINISTRATIVE CODE Copyright © 2025 by the New Jersey Office of Administrative Law