J.G., an indigent nursing home resident, applied for Medicaid benefits. While his Medicaid application was pending, J.G. passed away. Thereafter, the Essex County Division of Family Assistance and Benefits, the county welfare agency, denied J.G.’s Medicaid application, concluding he was ineligible as he died before eligibility could be met.

Future Care Consultants, J.G.’s designated authorized representative (DAR), submitted a timely appeal and request for a fair hearing to challenge the decision denying Medicaid benefits. The state Medicaid agency, the Division of Medical Assistance and Health Services (DMAHS), refused to transmit the appeal until an executor or estate administrator was appointed for J.G.’s estate. Because no executor or administrator was ever appointed for the estate, DMAHS denied the fair hearing request. J.G.’s DAR then appealed the denial of the fair hearing request to the Appellate Division of New Jersey’s Superior Court.

On appeal, DMAHS argued it failed to schedule a fair hearing because Future Care Consultants “lacked authorization from J.G.’s estate” to pursue a hearing. That is, Future Care Consultants’ status as J.G.’s designated authorized representative was extinguished upon J.G.’s death and Future Care Consultants was never appointed executor or administrator of J.G.’s estate.

The Court interpreted DMAHS’ position as a claim that Future Care Consultants did not have standing, and therefore, had no right to request a hearing. The Court disagreed, resolving the issue as follows:

We conclude that the Division shall transfer the matter to the [Office of Administrative Law] for it to address that standing claim. A hearing will permit the Division to exercise its “special competence” and address in the first instance whether FCC is an applicant with standing . . . If the OAL determines FCC has standing, the merits of the dispute related to the county welfare agency’s denial of benefits to J.G. should be considered at a fair hearing conducted consistent with fundamental notions of due process. In the event FCC is deemed not to have standing, the OAL should also determine whether J.G.’s estate should be permitted, under the circumstances, to identify a new DAR for the purpose of prosecuting J.G.’s claim at a fair hearing.

Thus, the Appellate Division remanded the case back to the county welfare agency for DMAHS to transfer the matter to the Office of Administrative Law for a hearing.

The case is attached here – J.G. v. Division of Medical Assistance and Health Services

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