A New Jersey appeals court held that a Medicaid application was properly denied when the applicant did not submit all the financial information and documents requested by the Medicaid agency. 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. resided in an assisted-living facility. Based upon an earlier pre-administrative screening, the local Medicaid agency, the Union County Welfare Board (CWB), determined that P.N. was medically eligible for Medicaid. However, P.N. had not been found financially eligible for Medicaid. As a result, P.N.’s attorney requested information from the CWB on applying for Medicaid. The attorney was told a letter would be sent scheduling an appointment.

When he did not receive an appointment or a letter, P.N.’s attorney sent a letter to the CWB advising that P.N. needed to apply for Medicaid. The letter requested “an appointment to present this Medicaid application.” CWB responded two months later, scheduling an appointment for P.N. to file a Medicaid application, and advising P.N. to bring various financial documents needed to complete the application process.

Although he submitted a Medicaid application at the appointment on P.N.’s behalf, P.N.’s attorney did not provide all the additional required information and documents. As a result, P.N’s application for Medicaid was “denied for failing to provide the necessary verifications to process the case.”

P.N. appealed. A hearing was held, and the administrative law judge affirmed the denial of benefits, finding P.N. failed to provide the required verifications and her assets exceeded the limit. The Director of the State Medicaid agency issued her final agency decision upholding the denial of benefits as appropriate because P.N’s application for Medicaid did not provide the information needed to determine financial eligibility.

P.N. again appealed. This time, the Superior Court of New Jersey, Appellate Division, considered the matter and upheld the final agency decision. The appeals court noted that P.N. did not dispute that information and documents needed to determine her financial eligibility for benefits were missing from her application. Based upon P.N.’s failure to provide the necessary information and documents, the appeals court found that the Medicaid agency properly denied the application. The court held that “[The state Medicaid agency] was 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.”

For the full text of this decision, click this link: P.N. v. Division of Medical Assistance and Health Services

For additional information concerning Medicaid applications and appeals, visit: https://vanarellilaw.com/medicaid-applications-medicaid-appeals/