Kenneth Vercammen, Esq is Chair of the ABA Elder Law Committee and presents seminars to attorneys and the public on Wills, Probate and other legal topics related to Estate Planning and Elder law. He is author of the ABA's book "Wills and Estate Administration. Kenneth Vercammen & Associates,
2053 Woodbridge Avenue - Edison, NJ 08817
(732) 572-0500 More information at www.njlaws.com/

Sunday, January 21, 2024

In Medicaid case plaintiff loses her for failure to timely respond to verification request

P.C., Petitioner-Appellant,

v.

MORRIS COUNTY DEPARTMENT OF FAMILY SERVICES,

Respondent-Respondent. _________________________

Submitted October 3, 2023 – Decided October 26, 2023

Before Judges Sumners and Perez Friscia.

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

We use initials to preserve the confidentiality of these proceedings. 3(c)(9).

R. 1:38-

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION
DOCKET NO. A-2630-21

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PER CURIAM NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

P.C. appeals from the March 18, 2022 final agency decision of the

Assistant Commissioner of the Division of Medical Assistance and Health Services (Division), which affirmed the Morris County Office of Temporary Assistance's (County) denial of P.C.'s Medicaid benefits. After a review of the record and applicable law, we affirm.

I.
On January 26, 2021, P.C.'s counsel filed an application for Medicaid

benefits with the County under the New Jersey FamilyCare Aged, Blind, Disabled Program. On February 9, 2021, in furtherance of P.C.'s application, the County by letter requested that she provide several eligibility verification documents, which she timely provided.

On February 25, 2021, the County sent P.C. a second verification request seeking additional documentation relating to: (1) a 2021 health insurance statement, (2) the 2020 sale of a house, and (3) verification for various bank accounts, including a Fidelity Investments account. Specifically, the Fidelity account verification documentation requested was as follows:

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7. Please provide statement for Fidelity [account] . . . from 01/26/2016 to 01/31/2021. Please also provide verification for any transactions for the amount of $2,000 and over. Verification must include copies of deposit slips and deposit check images, copies of withdrawal receipts, slips, invoices, etc, and copies of check receipts, check images, etc.

On June 3, 2021, the County sent P.C. a third verification request. The letter stated: "Failure to provide the requested information and documentation within [ten] calendar days from the date of this letter may result in a denial of your application" and again requested documentation relating to the Fidelity account. The County requested the following verification records for the Fidelity account:

Please also provide verification for any transactions for the amount of $2,000 and over. Verification must [include] copies of withdrawal receipts, slips, invoices, etc, and copies of check receipts, check images, etc.

A. Bank statement from 04/01/2018 to 06/01/2021. If the account was closed, please provide a letter from the bank stating so.
B. Withdrawal on 05/04/2016 for $ 6,500

C. Withdrawal on 01/25/2017 for [$] 2,200
On June 11, 2021, P.C.'s counsel emailed the County in response to the

third verification request and provided the County with most of "the requested documents per the letter." Additionally, P.C.'s counsel stated they were "working with Fidelity to obtain statements from April 2018-February 2019"

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and that "Fidelity [had] purged [the] account from their system" so P.C. had to "provide a letter of instruction with the information needed to be processed through a different department within Fidelity."

On July 12, 2021, one month after the provided June 13, 2021 submission deadline, P.C.'s counsel sent a letter to Fidelity seeking: account statements for the Fidelity account from April 2018 until February 2019; a transaction report for the May 4, 2016 withdrawal; a transaction report for the January 25, 2017 withdrawal; and a letter confirming the account was closed. The letter advised Fidelity that a "request is hereby made that you treat this request as urgent and provide the information requested above no later than July 28, 2021."

On August 9, 2021, as the County had not received any further communications from P.C., it mailed a "Retroactive Notice of Eligibility" to P.C.'s counsel advising P.C. was "determined ineligible" for Medicaid benefits for the months of October 2020 through December 2020. The County determined that P.C. failed to provide verification for a Chase account and the Fidelity account, including "[a] letter from the bank stating . . . the account was closed." The County advised P.C. that she could seek to "provide sufficient information to rebut [the] denial" and she could request a fair hearing within twenty days of the date of the letter.

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Two days after the denial, on August 11, 2021, Fidelity sent P.C.'s counsel a letter that confirmed the Fidelity account was closed on February 12, 2018. On August 13, 2021, two months after the June 13, 2021 deadline, P.C.'s counsel emailed a copy of the Fidelity letter to the County and stated, "Please see the attached letter from [F]idelity, there are no additional statements to be provided."

P.C. sought a fair hearing, and the Division transmitted the matter to the Office of Administrative Law on August 30, 2021. At argument before the Administrative Law Judge (ALJ), the County conceded "the only documentation that was not provided prior to its denial was information contained in the August 11, 2021 letter from Fidelity." The ALJ reversed the County's denial, finding P.C. acted in good faith to provide the documents requested and recommended the County's decision "must be reversed."

On March 18, 2022, the Assistant Commissioner for the Division issued a final agency decision, which rejected the ALJ's recommended reversal and affirmed the County's denial of the Medicaid application. The Assistant Commissioner noted that County requested on two separate occasions, February 25, 2021 and June 3, 2021, for P.C. "to provide information regarding her Fidelity account by June 13, 2021." The Assistant Commissioner stated that

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despite the County's June 13, 2021 deadline, P.C. "made no specific request for an extension of time" and only requested that Fidelity "provide the requested documentation by July 28, 2021," a month after receiving the request. The Assistant Commissioner recognized the County held P.C.'s application open for "nearly two months after [her] June 11, 2021 email," and found the County "was not able to complete its eligibility determination and the August 9, 2021 denial was appropriate." The Assistant Commissioner concluded the record contained "no documented exceptional circumstance warranting an extension of time beyond the 195 days the application remained open." This appeal followed.

II.
"This court's review of [the Division's] determination is ordinarily

limited." C.L. v. Div. of Med. Assistance & Health Services, 473 N.J. Super. 591, 597 (App. Div. 2022). "An administrative agency's decision will be upheld 'unless there is a clear showing that it is arbitrary, capricious, or unreasonable, or that it lacks fair support in the record.'" R.S. v. Div. of Med. Assistance & Health Servs., 434 N.J. Super. 250, 261 (App. Div. 2014) (quoting Russo v. Bd. of Trs., Police & Firemen's Ret. Sys., 206 N.J. 14, 27 (2011)). "The burden of demonstrating that the agency's action was arbitrary, capricious or unreasonable rests upon the [party] challenging the administrative action." E.S. v. Div. of

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Med. Assistance & Health Servs., 412 N.J. Super. 340, 349 (App. Div. 2010) (alteration in original) (quoting In re Arenas, 385 N.J. Super. 440, 443-44 (App. Div. 2006)).

"Deference to an agency decision is particularly appropriate where interpretation of the [a]gency's own regulation is in issue." I.L. v. N.J. Dep't Hum. Servs., Div. of Med. Assistance & Health Servs., 389 N.J. Super. 354, 364 (App. Div. 2006). "Nevertheless, we are 'in no way bound by the agency's interpretation of a statute or its determination of a strictly legal issue.'" C.L., 473 N.J. Super. at 598 (quoting R.S., 434 N.J. Super. at 261). Moreover, "[i]f our review of the record shows that the agency's finding is clearly mistaken, the decision is not entitled to judicial deference." A.M. v. Monmouth Cnty. Bd. of Soc. Servs., 466 N.J. Super. 557, 565 (App. Div. 2021) (first citing H.K. v. N.J. Dep't of Hum. Servs., 184 N.J. 367, 386 (2005), then citing L.M. v. Div. of Med. Assistance & Health Servs., 140 N.J. 480, 490 (1995)). The same is true "where an agency rejects an ALJ's findings of fact." Ibid. (citing H.K., 184 N.J. at 384).

"Medicaid is a federally-created, state-implemented program that provides 'medical assistance to the poor at the expense of the public.'" Matter of Estate of Brown, 448 N.J. Super. 252, 256 (App. Div. 2017) (quoting Estate of DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210,

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217 (App. Div. 2004)); see also 42 U.S.C. § 1396-1. To receive federal funding, the State must comply with all federal statutes and regulations. Harris v. McRae, 448 U.S. 297, 301 (1980).

Pursuant to the New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 to -19.5, the Division is responsible for administering Medicaid in our State. N.J.S.A. 30:4D-4. The Division is required to manage the State's Medicaid program in a fiscally responsible manner. See Dougherty v. Dep't of Hum. Servs., Div. of Med. Assistance & Health Servs., 91 N.J. 1, 4- 5, 10 (1982) (remanding back to the agency to consider the public interest and the "increasing social demands for limited public resources"). "[T]o be financially eligible, the applicant must meet both income and resource standards." Estate of Brown, 448 N.J. Super. at 257; see also N.J.A.C. 10:71- 3.15; N.J.A.C. 10:71-1.2(a).

One of the objectives of Medicaid is to "provide[] medical assistance to needy persons who are institutionalized in nursing homes as [a] result of illness or other incapacity." R.S., 434 N.J. Super. at 258 (quoting M.E.F. v. A.B.F., 393 N.J. Super. 543, 545 (App. Div. 2007)). The local County Welfare Agency (CWA) "exercise[s] direct responsibility in the application process to . . . [r]eceive applications." N.J.A.C. 10:71-2.2(c)(2). CWA is defined as "that

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agency of county government, that is charged with the responsibility for determining eligibility for public assistance programs, including [Aid to Families with Dependent Children]-Related Medicaid, Temporary Assistance to Needy Families (TANF), the Food Stamp Program, NJ FamilyCare and Medicaid." N.J.A.C. 10:71-2.1. The CWA is charged with evaluating an applicant's eligibility for Medicaid benefits. N.J.S.A. 30:4D-7a; N.J.A.C. 10:71-2.2(a); N.J.A.C. 10:71-3.15.

"The process of establishing eligibility involves a review of the application for completeness, consistency, and reasonableness." N.J.A.C. 10:71-2.9. Applicants must provide the CWA with specific verifications which are identified for the applicant. The CWA is responsible for assisting an applicant "in exploring their eligibility for assistance," N.J.A.C. 10:71-2.2(c)(3), and making known to the applicant "the appropriate resources and services both within the agency and the community, and, if necessary, assist in their use," N.J.A.C. 10:71-2.2(c)(4). The applicant is required to "complete, with the assistance from the CWA if needed, any forms required by the CWA as a part of the application process." N.J.A.C. 10:71-2.2(e)(1). While the applicant is "the primary source of information," the CWA is responsible for making "the determination of eligibility and to use secondary sources when necessary, with

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the applicant's knowledge and consent." N.J.A.C. 10:71-1.6(a)(2). The applicant is responsible for cooperating fully with the verification process if the CWA has to contact the third-party in reference to verifying resources. N.J.A.C. 10:71-4.1(d)(3)(i). The agency may perform a collateral investigation to "verify, supplement or clarify essential information." N.J.A.C. 10:71-2.10(b).

Following a review of the record and applicable legal principles, we affirm the Assistant Commissioner's final agency decision. P.C.'s argument that she provided the County with all the requested verifications is without merit. The Assistant Commissioner correctly noted that P.C. "was asked on two occasions, in February and June 2021, to provide information regarding her Fidelity account." It is additionally undisputed that the County required P.C. to submit a letter from Fidelity by June 13, 2021; however, P.C. did not submit the letter until August 11, 2021two months after the provided deadline and two days after the County denied her application.

P.C.'s contention that the Assistant Commissioner erred in finding she failed to effectively communicate with the County is also unavailing. The Assistant Commissioner observed that P.C.'s counsel "notified [the County] that . . . they were seeking additional documentation" on June 11, 2021, and thereafter "made no specific request of an extension" and did not notify the

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County of her efforts to obtain the letter. P.C. was required to provide evidence that corroborated her self-attested statement regarding the Fidelity account, and though P.C. advised the County that she was seeking additional evidence, she did not timely provide the required verification documents for nearly two months. Therefore, the Assistant Commissioner's decision finding that "[w]ith no additional communications or documentation" from P.C. following her June 11, 2021 email, the County "was not able to complete its eligibility determination and the August 9, 2021 denial was appropriate" was not arbitrary, capricious, or unreasonable.

To the extent we have not addressed any of plaintiff's remaining arguments, they are without sufficient merit to warrant discussion in a written opinion. R. 2:11-3(e)(1)(E).

Affirmed.

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Tuesday, January 16, 2024

Piscataway Library Estate Planning and Probate Seminar

 

Piscataway Library

Estate Planning and Probate  

March 12 , 2024 at 6pm live and also Facebook live.

 

SPEAKER: Kenneth Vercammen, Esq. Edison, (Author- ABA’s “Wills and Estate Administration book”)

 

Main Topics:

1.   What goes into a Will

2.   Dangers If You Have No Will or documents invalid

3.   Getting your Estate Planning Documents done when you don’t need to drive i a law office

4.   NJ Estate Tax eliminated and Inheritance Tax reduced

5.   Power of Attorneys recommendations

6.   Living Will & Advance Directive for Medical Care

7.   Administering the Estate/Probate /Surrogate

8.   Avoiding unnecessary expenses and saving your family money

 

Piscataway Public Library Kennedy Branch

500 Hoes Lane

Piscataway NJ 08854

732-463-1633x6

Link for free registration:

https://piscataway.librarycalendar.com/event/estate-planning-seminar-16542

 

more info:

https://piscatawaylibrary.org

 

FB _

  Free Will Seminars and Speakers Bureau for Groups

SPEAKERS BUREAU

         At the request of senior citizen groups, unions, and Middlesex County companies and organizations, the " Speakers Bureau " is a service designed to educate citizens about how laws affect their lives and how the judicial system operates.  We have attorneys available to speak to businesspersons, educational, civic and social organizations on a wide range of topics during business hours.  If your organization in Central NJ would like to schedule a Will & Estates seminar, call Kenneth Vercammen’s Law Office at 732-572-0500 or email Vercammenlaw@njlaws.com

 

     10 years ago the AARP Network Attorneys of the Edison/Metuchen/Woodbridge area several years ago established a community Speakers Bureau to provide educational programs to AARP and senior clubs, Unions and Middlesex County companies. Now, Ken Vercammen, Esq. and volunteer attorneys of the Middlesex County Estate Planning Council have provided Legal Rights Seminars to hundreds of seniors, business owners and their employees, unions, clubs and non-profit groups

Details on free programs available

    These quality daytime educational programs will educate and even entertain. Clubs and companies are invited to schedule a free seminar. The following Seminars are now available:

1. WILLS & ESTATE ADMINISTRATION-PROTECT YOUR FAMILY AND

MAKE PLANNING EASY

2. POWER OF ATTORNEY to permit family to pay your bills if you are temporarily disabled and permit doctors to talk with family

       All instructors are licensed attorneys who have been in practice at least 25 years. All instructors are members of the American Bar Association, New Jersey

State Bar Association, and Middlesex County Bar Association. All programs include free written materials.

    You don't have to be wealthy or near death to do some thinking about a Will. Here is your opportunity to listen to an experienced attorney who will discuss how to distribute your property as you wish and avoid many rigid provisions of state law.

   Topics discussed include: Who needs a Will?; What if you die without a Will (intestacy)?; Mechanics of a Will; "Living Will"; Powers of Attorney; Selecting an executor, trustee, and guardian; Proper Will execution; Inheritance Taxes, Estate Taxes $14,000 annual gift tax exclusion,  Bequests to charity, Why you need a "Self-Proving" Will and Estate Administration/ Probate.

 

       Sample materials: Hand-outs on Wills, Living Wills/Medical Advance Directive, Power of Attorney, Probate and Administration of an Estate, Real Estate, Working with your Attorney, Consumers Guide to New Jersey Laws, and Senior Citizen Rights.

 

SPEAKERS BUREAU

     At the request of senior citizen groups, unions, and Middlesex County companies and organizations, the " Speakers Bureau " is a service designed to educate citizens about how laws affect their lives and how the judicial system operates. We have attorneys available to speak to businesspersons, educational, civic and social organizations on a wide range of topics during business hours.

     In today's complex world, few people can function successfully and safely without competent legal advice. In order to insure your estate plans are legally set up, you need to know exactly where you stand so that you can avoid possibly catastrophic mistakes impacting both you and your family.

 

       About the speaker: Kenneth A. Vercammen is a trial attorney in Edison, NJ. We is the author of the American Bar Association’s book “Wills and Estate Administration”

He is co-chair of the ABA Probate & Estate Planning Law Committee of the American Bar Association Solo Small Firm Division.  He is a speaker for the NJ State Bar Association at the annual Nuts & Bolts of Elder Law & Estate Administration program.

He was Editor of the ABA Estate Planning Probate Committee Newsletter. Mr. Vercammen has published over 150 legal articles in national and New Jersey publications on litigation, elder law, probate and trial topics. He is a highly regarded lecturer on litigation and probate law for the American Bar Association, NJ ICLE, New Jersey State Bar Association and Middlesex County Bar Association. His articles have been published in noted publications included New Jersey Law Journal, ABA Law Practice Management Magazine, and New Jersey Lawyer. He established the NJlaws website www.njlaws.com which includes many articles on Estate Planning, Probate and Wills. He is a member of the AARP and often lectures to groups on the importance of an up to date Will, Power of Attorney and Living Will.

 KENNETH  VERCAMMEN & ASSOCIATES, PC

ATTORNEY AT LAW

2053 Woodbridge Ave.

Edison, NJ 08817

(Phone) 732-572-0500

www.njlaws.com