A New Jersey appeals court rules that the state properly denied Medicaid benefits to an applicant who did not submit all the financial information requested. P.N. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-2025-15T2, July 28, 2017).
P.N. lived in an assisted living facility. In October 2013, her attorney requested information from the local Medicaid agency on applying for Medicaid. The attorney never received an appointment, so the attorney sent the agency a letter requesting an appointment to present her Medicaid application. P.N. attended the appointment and submitted her application for Medicaid in June 2014. When P.N. did not provide additional financial information the agency requested, it denied her application.
P.N. appealed, and the administrative law judge affirmed the denial of benefits because she failed to provide the required verifications and her assets exceeded the limit. P.N. appealed, arguing that the state should be estopped from denying the application retroactive to October 2013.
The New Jersey Superior Court, Appellate Division, affirms the denial of Medicaid benefits because P.N. did not provide verifying information. The court holds that the state is "correct to deny an application that did not have the information necessary to verify eligibility because Medicaid is intended to be a resource of last resort and is reserved for those who have a financial or medical need for assistance." The court also notes that the October 2013 phone call did not constitute an application for benefits.
For the full text of this decision, go to: https://www.njcourts.gov/attorneys/assets/opinions/appellate/unpublished/a2025-15.pdf
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