A Superior Court judge in Ocean County dismissed a lawsuit filed by a nursing home for unpaid bills against a power of attorney appointed by a former resident, and ordered the nursing home to pay legal fees incurred by the power of attorney, ruling that the law prohibited the nursing home from requiring the power.. read more →

After being denied Medicaid because of a $70,000 joint bank account she maintained with her son, the Medicaid applicant, S.M., appealed the case to An administrative hearing. S.M. argued that Medicaid had failed to consider that her son was the sole source of $60,000 of those bank funds. After the ALJ affirmed Medicaid’s denial, and.. read more →

Nursing home resident Joseph Gamma died after falling off his bed at the facility. His estate sued the nursing home. One of the claims the estate asserted was that the nursing home had violated the New Jersey Nursing Home Responsibilities and Residents’ Right Act (“the Nursing Home Act”). At the conclusion of the trial, the.. read more →

Applying New Jersey’s filial support law, an appeals court in Pennsylvania affirmed a decision denying a Pennsylvania residential facility’s effort to hold the elderly New Jersey parents of an adult resident liable for the unpaid balance of his specialized services. Melmark v. Schutt (Pa. Super., No. 2253 EDA 2016, July 19, 2017). New Jersey resident Alexander (Alex).. read more →

A U.S. district court ruled that a group of Medicaid applicants do not have a private right of action to sue the state for not issuing Medicaid eligibility determinations with 45 days and that the applicants were not denied due process by the delay. Evangelical Lutheran Good Samaritan Society, Inc. v. Randol  (U.S. Dist. Ct., D… read more →

In this case, the Division of Medical Assistance and Health Services (DMAHS), New Jersey’s state Medicaid agency, affirmed the denial of a Medicaid application filed by Grace M. Vinci (G.V.) by the Monmouth County Division of Social Services (MCDSS) finding that G.V. had resources in excess of $2,000 available to her, namely, resources contained in.. read more →

Kindred v. Clark involves two Kentucky cases, in which family members of deceased Kindred nursing home residents, Joe Wellner and Olive Clark, filed lawsuits against Kindred. They alleged that Kindred’s substandard care led to the deaths of the decedents. In response, the nursing home moved to dismiss the cases, claiming that arbitration agreements barred the.. read more →

The federal Nursing Home Reform Law was enacted in 1987, and became effective in October 1990. The Reform Law governs any nursing facility that accepts reimbursement from Medicare or Medicaid, and applies to all residents in any such facility, regardless of the individual resident’s payment source. In other words, the law applies whether the resident’s.. read more →

A U.S. district court denied a preliminary injunction to a Medicaid applicant who sued New Jersey to prevent the state from denying benefits based on her dead husband’s assets. Flade v. Connolly (U.S. Dist. Ct, D. N.J., No. 16-4407, Sept. 23, 2016). Plaintiff, Eileen Flade, was a nursing home resident. On April 12, 2016, plaintiff applied for.. read more →

A New York trial court entered judgment against a woman who refused to contribute to her spouse’s nursing home expenses, finding that because she had adequate resources to do so, an implied contract was created between her and the State of New York entitling the state to repayment of Medicaid benefits it paid on the.. read more →

McHugh Fuller, a law firm which focuses on nursing home abuse and neglect, ran a full-page ad in The Toccoa Record, a Georgia newspaper. The ad stated that Heritage Healthcare of Toccoa, a nursing home owned by PruittHealth, was cited for deficiencies in the care of its residents. Also in the ad, the law firm invited.. read more →

A New Jersey appeals court ruled that payments to the spouse of a Medicaid recipient from an annuity purchased with the spouse’s “resource allowance” were properly considered “income” to the spouse under the Medicaid rules. J.G. v. Division of Medical Assistance and Health Services J.G., who was married to M.G. for 67 years, suffered from Alzheimer’s.. read more →

The New York State Bar Association has issued a brochure to help consumers understand the benefits of utilizing an elder law attorney to assist (1) in the preparation of Medicaid applications and (2) in planning for yourself or a loved one to protect assets when seeking eligibility for public benefits based upon financial need. The.. read more →

A New Jersey appeals court held that a needs-based credit applied to the accounts of residents of an assisted living facility counts as income for Medicaid eligibility purposes. R.W. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-4911-13T1, Feb. 22, 2016). This case was brought by several residents of the.. read more →

After he was admitted to a nursing home in 2013, petitioner, R.P., accrued unpaid bills of $264,146 for nursing care services. As a result, three successive Medicaid applications were filed on R.P.’s behalf. It was undisputed that R.P. lacked the capacity to assist with any of the Medicaid applications. The first Medicaid application, filed in.. read more →

M.S. is a 73-year old residing in at a long-term care facility. She is a hemiplegic who suffers from obesity, diabetes, arthritis, osteoporosis and COPD. Because she is completely paralyzed on her left side, she had been using a manual one-arm wheelchair. She filed an application to the Division of Medical Assistance and Health Services.. read more →

The Superior Court of New Jersey, Appellate Division, affirmed a decision of the Director of New Jersey Medicaid reversing a ruling of an Administrative Law Judge (ALJ) who reduced C.W.’s Medicaid ineligibility penalty previously assessed for transferring assets for less than fair market value. C.W. v. Divison of Medical Assistance and Health Services, Docket No. A-2352-13T2.. read more →

Plaintiff Wilson Bermudez was a patient at Kessler Institute for Rehabilitation’s West Facility for five weeks, during which his treatment included 24-hour rehabilitative nursing “to address complex medical, nursing, and rehabilitative needs.” When Bermudez later sued Kessler for injuries he allegedly sustained, he included claims under the New Jersey Nursing Home Responsibilities and Rights of.. read more →

An Administrative Law Judge found a Medicaid applicant eligible for benefits even though the applicant was impoverished because her spouse gambled away a substantial inheritance. M.Y v. Union County Board of Social Services M.Y., a 96 year old woman, suffered from dementia, could not care for her own needs, and was destitute. She was admitted.. read more →

To be eligible for Medicaid, applicants must meet two requirements: financial requirements and medical requirements. I’ve posted many articles on this blog over the years discussing the financial requirements of the Medicaid program in New Jersey, and offering various strategies to accelerate financial eligibility for the program. However, I have surprising few posts discussing Medicaid’s.. read more →

As discussed in a prior blog post, a major overhaul of Medicaid will be introduced in New Jersey in the coming months. The new Medicaid program is called Managed Long Term Services and Supports (MLTSS). The MLTSS implementation date has been repeatedly adjourned, and the next date scheduled to put the new program into effect.. read more →

An appeal of a claim for Medicaid benefits that was filed late may be considered when the applicant shows that the filing deadline should be extended due to “extraordinary and extenuating circumstances.” Reuter v. Division of Medical Assistance and Health Services, Docket No. A-0514-13T2 (App. Div., October 17, 2014) Plaintiff, Greta Reuter, a nursing home.. read more →

Gifts made during the Medicaid look-back period result in a penalty, or period of ineligibility, unless the applicant can prove that the gifts were made exclusively for some purpose other than to qualify for Medicaid. S.L. v. Division of Medical Assistance and Health Services, Docket No. A-3520-11T4 (App. Div., September 2, 2014) In December 2009,.. read more →

The Medicaid programs in New Jersey which help residents pay long-term care costs are about to get a major overhaul. Currently, there are three (3) Medicaid programs in New Jersey that pay for long-term care costs. The Medicaid-Only Medicaid program pays the costs of caring for nursing home residents. A companion program, Global Options for.. read more →

A nursing home resident’s adult child who signs an admission agreement as the “Responsible Party” can be sued in his/her individual capacity for services rendered to the resident, if the adult child fails to use the resident’s financial resources to pay for care provided by the facility. Manahawkin Convalescent v. O’Neill, 217 N.J. 99 (2014)… read more →