In three similar matters, a New Jersey appeals court upholds the state Medicaid agency’s decisions denying untimely requests for fair hearings to review long-term care eligibility decisions. S.H. v. Div. of Med. Assistance & Health Servs. (N.J. Super. Ct., App. Div., No. A-0277-15T1, April 2, 2018); A.S. v. Div. of Med. Assistance & Health Servs. (N.J. Super. Ct., App. Div., No. A-0276-15T1, April 10, 2018); J.C. v. Div. of Med. Assistance & Health Servs. (N.J. Super. Ct., App. Div., No. A-0775-15T4, April 11, 2018).
In the first case, S.H. applied for Medicaid long-term care benefits. The agency notified S.H.’s representative that S.H. was eligible for benefits but subject to a penalty period for transferring assets for less than fair market value. The notice advised that S.H. could request a fair hearing to review the decision or seek a hardship waiver if filed within 20 days. Eleven months later, the nursing home where S.H. resided, acting as his representative, requested a hardship waiver on S.H.’s behalf. The state Medicaid agency denied the request for a fair hearing as being untimely and the nursing home appealed.
In the second case, A.S.’s personal representative filed an application on her behalf for long-term care benefits. However, the application, and a subsequently filed one, failed to provide necessary financial information and Medicaid denied them both, each time advising A.S.’s representative of the right to request a fair hearing. A fair hearing was not requested. Later, the nursing home where A.S. resided sought to reopen the case but the request was denied because A.S. had been determined to be over the resource limit. Nine months later, acting as A.S.’s representative, the nursing home requested a fair hearing to review the agency’s decision to deny Medicaid benefits. The agency denied the request for a fair hearing as being untimely and the nursing home appealed.
In the third case, after entering a nursing home J.C. was notified that she had been found eligible for long-term care benefits but subject to an asset transfer penalty. The notice advised J.C. of her right to request a fair hearing or to request a hardship waiver within 20 days. Subsequently, the nursing home where J.C. resided requested a fair hearing of the agency’s decision on her behalf but it did so before being designated as J.C.’s personal representative. Ultimately, the nursing home failed to perfect its request for a fair hearing until more than four months after the eligibility notice was issued, and the request was denied as being untimely. The nursing home appealed the agency’s decision denying the request for a fair hearing.
Each of the three appellants was represented by the firm of Schutjer Bogar LLC.
In each case, the New Jersey Superior Court, Appellate Division, affirms the agency’s decisions and finds no error in denying the personal representatives’ requests for a fair hearing made significantly outside of the time limits established by Medicaid regulations.
For the full text of S.H. v. Div. of Med. Assistance & Health Servs., click here.
For the full text of A.S. v. Div. of Med. Assistance & Health Servs., click here.
For the full text of J.C. v. Div. of Med. Assistance & Health Servs., click here.
To read a summary of A.S. v. Div. of Med. Assistance & Health Servs., written by New Jersey ElderLawAnswers member attorney Donald Vanarelli, click here.
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