C.G. v. Division of Medical Assistance and Health Services, 091619 NJSUP, A-3898-17T4

Docket Nº:A-3898-17T4
Opinion Judge:PER CURIAM
Party Name:C.G., Petitioner-Appellant, v. DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, and ATLANTIC COUNTY BOARD OF SOCIAL SERVICES, Respondents-Respondents.
Attorney:SB2, Inc., attorneys for appellant (Laurie M. Higgins, on the briefs). Gurbir S. Grewal, Attorney General, attorney for respondent New Jersey Department of Human Services, Division of Medical Assistance and Health Services (Melissa H. Raksa, Assistant Attorney General, of counsel; Jacqueline R. D...
Judge Panel:Before Judges Fasciale and Moynihan.
Case Date:September 16, 2019
Court:Superior Court of New Jersey
 
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C.G., Petitioner-Appellant,

v.

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, and ATLANTIC COUNTY BOARD OF SOCIAL SERVICES, Respondents-Respondents.

No. A-3898-17T4

Superior Court of New Jersey, Appellate Division

September 16, 2019

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Submitted September 9, 2019

On appeal from the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

SB2, Inc., attorneys for appellant (Laurie M. Higgins, on the briefs).

Gurbir S. Grewal, Attorney General, attorney for respondent New Jersey Department of Human Services, Division of Medical Assistance and Health Services (Melissa H. Raksa, Assistant Attorney General, of counsel; Jacqueline R. D'Alessandro, Deputy Attorney General, on the brief).

Before Judges Fasciale and Moynihan.

PER CURIAM

C.G. appeals from a March 19, 2018 final agency decision by the Department of Human Services Division of Medical Assistance and Health Services (DMAHS) upholding an initial determination by an administrative law judge (ALJ) denying C.G.'s Medicaid application for failure to provide necessary financial verifications.1 DMAHS concluded that the failure to produce that information prevented the county welfare agency (CWA) from completing a required eligibility determination. We affirm.

In July 2015, C.G.'s daughter-in-law (A.S.G.) filled out C.G.'s application. In March 2017, after it resolved C.G.'s request for a spousal waiver, the CWA processed C.G.'s name using its Asset Verification System (AVS). That uncovered a discrepancy between who had been the rightful owner of a TD bank account. A.S.G. submitted information saying C.G.'s son owned it, but the AVS report indicated C.G. was the owner. The CWA requested bank account statements, beginning in October 2013.

In May 2017, FCC (which became C.G.'s designated representative) responded partially by producing a statement covering only September 2015 to October 2015. That statement conflicted with the one submitted by A.S.G., which showed that C.G.'s name and pension information had been deleted. On the statement that FCC produced, C.G.'s pension income appeared, but that information was missing on the Medicaid application.

In May and June 2017, the CWA renewed its request for the verifications. On July 5, 2017, the CWA notified FCC that it would deny the application unless FCC submitted the verifications within ten days. FCC failed to comply with the deadline, and the CWA denied C.G.'s application on July 27, 2017. In September 2017, C.G. purportedly subpoenaed information. In early December 2017, C.G.'s counsel produced additional documentation to the CWA.

One week later, the ALJ conducted a hearing. The ALJ found that no exceptional circumstances existed warranting the late submission of the requested information. The ALJ concluded, based on the record before the CWA, that C.G. failed to produce the requested information in accordance with N.J.A.C. 10:71-2.2(e) and N.J.A.C. 10:71-3.1(b); that the CWA appropriately processed the...

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