State Cannot Get Appeal Extension on Medicaid Eligibility Decision After "Inadvertent Oversight"

Feb 6th, 2012

A New Jersey appeals court rules that an administrative law judge's Medicaid eligibility decision is final after 45 days and the state cannot have an extension to appeal the decision after the deadline has passed except in the case of an emergency. J.L. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-4515-09T3, Feb. 3, 2012).

J.L. and S.L. received Medicaid benefits for themselves and their children. J.L. received a $45,000 gift from his brother that was earmarked for the purchase of a family home. J.L. also received a $20,000 inheritance from his grandfather, which he intended to use to help purchase the home. The state found that due to the gift and the inheritance, J.L. was no longer eligible for Medicaid, and J.L. appealed.

An administrative law judge (ALJ) ruled that because the gift and the inheritance were earmarked for the purchase of a marital home, they were exempt assets for the purposes of Medicaid eligibility. Under state law, the ALJ's decision became final 45 days after it was delivered. After the 45-day statutory deadline passed, the state requested an extension of the final decision, arguing that "due to an inadvertent oversight" it had failed to request an extension on time. The Division of Medical Assistance and Health Services approved the extension request and found that the inheritance was not specifically earmarked for the purchase of the home, so it was not exempt. J.L. appealed.

The New Jersey Superior Court, Appellate Division, reverses, holding that after the 45-day statutory period has elapsed, the state may ask for an extension only for an emergency or an unforeseeable circumstance, and that an inadvertent oversight is not an emergency. According to the court, the Division should not have granted the extension and the ALJ's decision is final.

For the full text of this decision in PDF, go to: http://www.judiciary.state.nj.us/opinions/a4515-09.pdf.

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