NJ Appeals Court Rules Medicaid Applicant’s Resources Available Despite Guardian’s Difficulty Accessing Financial Information

H.R., who had significant cognitive and functional deficits, was admitted to the Hammonton Center for Rehabilitation and Healthcare (Hammonton Center).  The Hammonton Center filed a complaint seeking the appointment of a guardian for H.R.

While H.R.’s guardianship was still pending, the Hammonton Center filed a Medicaid application with the Atlantic County Board of Social Services (ACBSS) on H.R.’s behalf. The ACBSS Medicaid Long Term Care Unit (LTC Unit) denied H.R.’s application, as H.R. “failed to provide documents needed to make [a] determination.” No appeal was filed.

H.R.’s guardian filed two more applications for Medicaid. In the last application, the guardian represented that H.R. owned real property, the fair market value of which was $5000, and three bank accounts, which contained assets of approximately $14,000, leaving H.R. with total countable resources of about $19,000.

Soon after the guardian filed the final Medicaid application, H.R. passed away. One week later, the Court ordered the guardian to spend down H.R.’s assets on care costs and other costs, which was accomplished.

Thereafter, H.R.’s Medicaid application was denied by the LTC Unit as H.R. was deceased and “over-resourced,” since his estate was “over the $2000 resource limit.”

The guardian filed a request for a fair hearing, appealing the denial of Medicaid benefits.  The guardian argued that H.R.’s cognitive impairment, death, and the state of his property along with the delay in issuing letters of guardianship and the guardian’s difficulty receiving information from financial institutions, rendered H.R.’s resources unavailable. The state denied the appeal, and the guardian appealed to court.

In court, the guardian claimed that H.R.’s cognitive impairment, his death, the state of his land, the delay in issuing letters of guardianship, and the guardian’s difficulty receiving information from the financial institutions, rendered H.R.’s resources unavailable. As a result, the guardian claimed that “the value of a resource that is inaccessible through no fault of the applicant is expressly excluded by N.J.A.C. 10:71-4.4(b)(6).”

The New Jersey Superior Court, Appellate Division, rejected the guardian’s argument and affirmed the denial of benefits, ruling as follows:

While we acknowledge the guardian experienced some difficulty obtaining information regarding [H.R]’s assets, she was aware of [his bank accounts], albeit shortly before [H.R]’s death, and possessed authority to access that resource prior to filing the [final] Medicaid application.

Further, according to the court, even if the bank account was inaccessible, H.R.’s property put him over the resource limit.

The case is annexed here – H.R. v. Division of Medical Assistance and Health Services (App. Div.)

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