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.. read more →
On August 10, 2017, I presented at the 2017 Sophisticated Elder Law Program on Medicaid litigation strategies. I provided an overview of various strategies and tactics which have been used successfully in litigation involving Medicaid and other needs-based public benefits in state and federal courts and in administrative agencies. I prepared a paper and PowerPoint slides.. 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 →
New Jersey’s Division of Consumer Affairs (DCA) released a Consumer Brief on Medicaid Advisors/Application Assistors. Medicaid Advisors/Application Assistors are non-lawyers who provide limited services without payment or compensation in connection with Medicaid applications. According to the DCA Consumer Brief, the limited services which Medicaid Advisors/Application Assistors may perform include the following: providing information on insurance.. 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 →
In this case, the Court considered whether a Medicaid applicant received full and fair notice of the reasons for the agency’s decision to deny benefits prior to holding a hearing on the applicant’s appeal. E.W. v. Cape May County Board of Social Service, OAL Docket. No. HMA 14667-15 (OAL December 24, 2015) In 2012, E.W.,.. read more →
In a recent opinion, an appellate court in Minnesota held that county officials were not liable for incorrectly telling a Medicaid applicant that his estate would not be subject to a Medicaid lien because the applicant could have hired a lawyer to learn the correct information. Benigni v. St. Louis County (Minn. Ct. App., No. A15-1154, June.. read more →
The Committee on the Unauthorized Practice of Law, appointed by the Supreme Court of New Jersey, recently issued Opinion 53 in which the Court considered weather non-lawyers who assisted applicants and beneficiaries in applying for Medicaid benefits were engaged in the unauthorized practice of law. The Court identified the non-lawyers providing Medicaid assistance as “Medicaid.. 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 →
The Alzheimer’s Association has issued its 2016 Alzheimer’s Disease Facts and Figures report. The report is “a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia, as well as other dementias.” Aside from providing a definition of Alzheimer’s disease (“Alzheimer’s disease is a degenerative brain disease and the most common cause of.. read more →
Medicaid, unlike Medicare, is a public benefit program based upon financial need. As a result, you are eligible for Medicaid only if you are over age 65, blind or disabled, and have few assets. If an applicant is married, all assets in the sole name of the husband, in the sole name of the wife, and.. 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 →
A court in Connecticut ruled that the administrator of an estate lacked standing to appeal the denial of an application for Medicaid benefits because no appeal of the denial was filed before the decedent died. Freese v. Department of Social Services (Conn. Super. Ct., No. CV14-6047417S, June 1, 2015). Plaintiff, Kathleen Freese, claimed that the defendant, Department.. read more →
Two years ago, in 2013, a federal judge in New Jersey granted a preliminary injunction to Elizabeth Flamini, a Medicaid applicant who successfully sued for an injunction preventing the State of New Jersey from counting an annuity owned by Mrs. Flamini’s husband Angelo as an available resource in determining Medicaid eligibility. Flamini v. Velez ,.. 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 →
In A.H. v. Division of Medical Assistance and Health Services, 2014 N.J. Agen. LEXIS 91 (OAL Dkt. No. HMA 00531-13, Jan. 27, 2014), fifteen months elapsed between the assisted living facility resident’s application for Medicaid benefits under the “Global Options” program and the formal denial of the claim. During this time, in which there were.. read more →
In a very unusual ruling, a New York appeals court ruled that, despite transferring significant assets to family members, an applicant still qualified for Medicaid because the transfers were made exclusively for a purpose other than to qualify for benefits. Matter of Safran v. Shah, Docket No. D42144 (App. Div., 2nd Dept., July 2, 2014).. read more →
As a result of the advocacy efforts by several New Jersey elder law attorneys following a class action lawsuit filed against the State of New Jersey, New Jersey Medicaid’s penalty divisor will be increased to $9,535.62 per month, or $313.50 per day, effective April 1, 2014. The newly increased divisor shall be used for all new or pending.. read more →
What Is Medicaid? Medicaid is a government program through which many elderly and disabled people receive care at home or in a nursing home. Medicaid is a statewide program, currently administered In New Jersey through each county’s Board of Social Services. The state agency in New Jersey responsible for administering the Medicaid program is the.. read more →
In this case, the United States District Court for the Southern District of New York granted summary judgment for plaintiffs in a lawsuit alleging that the State of New York failed to render final decisions following Fair Hearings within the ninety-day period following the filing of Fair Hearing requests as required by federal and state.. read more →
A New York appeals court allowed a case for legal malpractice and breach of fiduciary duty to proceed against an attorney who charged more than $44,000 for Medicaid planning work to protect a net estate valued at about $130,000. Sobel v. Ansanelli, (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2011-11418, Sept. 19, 2012). In.. read more →
The Director of New Jersey Medicaid recently decided that, when a couple is institutionalized, the resources of the couple are not combined when determining Medicaid eligibility. Rather, the resources of each spouse must be considered separately. Therefore, when only one spouse applies for Medicaid benefits and that spuse’s resources alone do not exceed the resource.. read more →
A.D., a retired physician, began residing at Bergen Regional Medical Center (Bergen Regional), a nursing home, in October 2004. She was 80 years old at the time. She began receiving Medicaid benefits in late 2004. In 2006, the Bergen County Board of Social Services (Board) discovered two Keogh accounts at Citibank in A.D.’s name valued.. read more →
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