Petitioner, J.F., through his daughter and power of attorney, M.P., applied for Medicaid benefits. The county welfare agency requested five years of bank statements from his checking account and told him the application would be denied if the requested information was not provided by April 23, 2015. M.P. asked for an extension of time. In her request, M.P. stated that the checking account was closed and its statements had been archived by the bank. The county welfare board granted an extension to May 13, 2015.

On May 14, 2015, one day after the expiration of the extended deadline, M.P. submitted a bank receipt for the checking account showing the account was closed account with a final balance of $19.16. M.P. provided the other materials requested by the county welfare board by the May 13, 2015 deadline. M.P. did not seek a further extension to produce the checking account records.

The county welfare agency denied the Medicaid application. M.P. appealed, filing for a fair hearing on petitioner’s behalf. The matter was transferred to the Office of Administrative Law, where a fair hearing was held. At the hearing, petitioner claimed (1) that the county welfare board was required by federal and state law to assist him in obtaining the financial information necessary to verify his application, and (2) that the information he submitted was sufficient.

The administrative law judge (ALJ) issued an initial administrative decision affirming the denial of benefits. The ALJ determined that nothing in the regulations required the county welfare agency to assume the applicant’s obligation to submit the information necessary to complete his application and verify his eligibility for benefits. In addition, the ALJ also concluded that the information provided by M.P. was insufficient to establish eligibility for benefits because the agency is entitled to examine transfers of assets during a sixty- month look-back period.

The Director adopted the ALJ’s decision. J.F. appealed again, this time to the Superior Court, Appellate Division. On appeal, J.F.  again argued that the denial of Medicaid benefits should be reversed because: (1) the information submitted with respect to his checking account was sufficient for the county welfare agency to verify his eligibility for benefits; and (2) the county welfare agency violated both state and federal law by failing to assist him in completing his Medicaid application.

The court affirmed the denial, holding that while the county welfare agency was required to contact an applicant’s financial institution to verify an account’s existence, it was not required to obtain records directly from a financial institution. Additionally, the fact that petitioner’s account had a small amount in it when it was closed did not shed light on transfers from that account during the 60 months look-back period.

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

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