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Denial of Eligibility Upheld Where Applicant Failed to Cure Penalty

An applicant filed three Medicaid applications from February 7 through November 26, and all of them were denied for failure to submit necessary financial verification. A fair hearing was conducted on November 26, 2018 where the ALJ gave the applicant additional time to supply verification. Once that verification was supplied, on May 14, 2019, the Division gave the applicant until June 3, 2019 to cure a $688,418 transfer of resources penalty. She failed to meet the deadline, so the penalty was imposed. Later, the applicant filed a new application for Medicaid. The Division stood by its earlier decision. When the applicant requested a fair hearing, the Division refused. Upholding the decision below, the Court held:

The Division was explicit in multiple letters to R.M. that it decided her Medicaid benefit eligibility on June 6. She was deemed eligible at that time, subject to a transfer penalty. Once she missed her opportunity to address the penalty issue by June 3, she could have pursued a fair hearing on the June 6 eligibility decision and presented any objections to it within twenty days. She did not do so. R.M.’s July 30 application appears to be her attempt to restart the clock, and she has made no showing that the Division in any way failed to follow the law or was arbitrary, capricious, or unreasonable. R.S., 434 N.J. Super. at 260-61, 83 A.3d 868. In fact, the Division’s actions in disregarding the July 30 application are amply supported in the record.

R.M. v. Div. of Med. Assistance & Health Servs., Superior Court of New Jersey, Appellate Division, Docket No. A-3079-19
Decided March 8, 2021

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