A New Jersey appeals court rules that the state wrongly denied a Medicaid applicant's request for a hearing as untimely when there was no evidence the letter denying her benefits ever reached her. Reuter v. Burlington County Board of Social Services (N.J. Super. Ct., App. Div., No. A-0514-13T, Oct. 17, 2014).
Nursing home resident Greta Reuter applied for Medicaid benefits. The state prepared a letter dated March 28, 2013, that granted Ms. Reuter retroactive benefits, but denied her additional benefits because she had not provided the information it requested about her inheritance from her husband. The letter notified Ms. Reuter that she had 20 days to request a fair hearing. The letter was not sent by certified mail, and Ms. Reuter claimed she never received it.
On July 25, 2013, Ms. Reuter's attorney contacted the state to find out about her claim and learned that she had been denied benefits. Eight days later, the attorney requested a fair hearing. The state denied the request as untimely. Ms. Reuter appealed to court.
The New Jersey Superior Court, Appellate Division, holds that the state acted arbitrarily and capriciously in denying the fair hearing without any evidence that the letter reached Ms. Reuter. The court notes that "[g]iven the totality of circumstances here, it would strain common sense for appellant, her family members, and her attorney to have disregarded the letter when it supposedly arrived and have waited 127 days to pursue a fair hearing." The court requires Ms. Reuter to submit a certification that she never received the letter and remands the case to the state.
For the full text of this decision, go to: https://www.judiciary.state.nj.us/opinions/a0514-13.pdf
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