No Evidence that Medicaid Applicant's Transfers Were to Employ Live-in Aide

A New Jersey appeals court rules that a Medicaid applicant who made transfers failed to rebut the presumption that those transfers were for a purpose other than to qualify for Medicaid even though an administrative law judge found evidence that the applicant transferred the money to employ a live-in aide. N.K. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-3365-14T2, July 19, 2016).

Nursing home resident N.K. applied for Medicaid benefits. The state determined that she had made a number of transfers within the look-back period and imposed a seven-month penalty period. N.K.'s checking account had $69,200 in checks made out to "cash."

N.K. appealed and argued at a hearing that she withdrew the money to pay a live-in aide. After listening to testimony from family members, the administrative law judge (ALJ) determined that N.K. employed a live-in aide and had successfully rebutted the presumption that she transferred the money in order to qualify for Medicaid. The director of the Division of Medical Assistance and Health Services reversed the ALJ's decision, ruling that there was no evidence supporting the testimony of N.K.'s family members. N.K appealed to court.

The New Jersey Superior Court, Appellate Division, affirms, holding that there was no evidence to support the ALJ's findings. The court rules that "N.K.'s family provided nothing more than assumptions and speculations about [the aide] and the purpose of the disputed checks." According to the court, "the record is devoid of credible documentary evidence of the fair market value of the transferred assets, and devoid of convincing evidence that the assets were transferred exclusively for a purpose other than to establish Medicaid eligibility."

For the full text of this decision, go to: https://www.judiciary.state.nj.us/opinions/a3365-14.pdf

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