A New Jersey court upholds an administrative law judge’s (ALJ) denial of Medicaid benefits where the claimant’s bank refused to explain in writing a mistake contained in an investment account statement. A.R. v. Division of Medical Assistance and Health Services (N J. Super. Ct. App. Div., No A-0077-16T4, July 17, 2018).
A.R. applied for Medicaid through Senior Planning Services (SPS) on February 13, 2015. His application referenced an investment account he held at PNC bank. That same day, the Ocean County Board of Social Services requested more information about the account, and SPS reported activity within the five-year look-back period that ended in an account balance of zero.
In both June and September 2015, the Board requested verification of the account activity. SPS’s explanations that the PNC statement had been a mistake were followed by an October 27, 2015, phone call involving SPS, the Board, and PNC. During the call, the PNC representative discussed what had occurred but advised that it would not provide a written explanation. The Board denied A.R.’s Medicaid application the next day because it had not received written verification of the investment account activity.
A.R. filed a new Medicaid application on November 25, 2015. In December, PNC sent a letter explaining what had happened with the account, and A.R.’s application was approved later that month. A.R. appealed the October 2015 denial of benefits, arguing that the Board never requested a written verification from PNC.
The ALJ found that PNC’s oral explanation and reference to the “self-explanatory” nature of the statements did not comply with New Jersey law requiring written verification of resources. The ALJ upheld the original denial. A.R. appealed the ALJ’s decision.
The Superior Court of New Jersey, Appellate Division, affirms the ALJ’s denial of Medicaid benefits. Limiting its review to a determination of whether the agency’s action was “arbitrary, capricious, or unreasonable,” the court found that requiring a written response from PNC in response to its request for verification was neither arbitrary, capricious, nor unreasonable. “It was clear the Board wanted written verification from PNC about the account,” the court writes. The court concludes that New Jersey law commands that an applicant fully cooperate in the process and provide written authorization allowing the Board to receive the information it seeks.
For the full text of this decision, click here.
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