Burden Is on Medicaid Applicant to Provide Verifying Bank Statements

A New Jersey appeals court holds that the state was not required to assist a Medicaid applicant by obtaining debit card statements from her bank to verify her application. C.F.J. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-4385-16T4, Dec. 11, 2018).

C.F.J. entered a nursing home and applied for Medicaid. The Medicaid agency denied the application because C.F.J. had not submitted debit card statements. Eventually, C.F.J.'s attorney subpoenaed the bank and was able to obtain the statements.

C.F.J. appealed the denial. After a hearing, the administrative law judge ruled that the Medicaid agency was required to obtain the information electronically through the federally mandated asset verification system (AVS) or if not available electronically, through a third-party source. The director of the Medicaid agency overruled the ALJ and upheld the Medicaid denial. C.F.J. appealed to court.

The New Jersey Superior Court, Appellate Division, affirms, holding that C.F.J. had the burden of providing the debit card statements within the time required for the Medicaid agency to process the application. According to the court, the debit card statements were not available through the AVS system, and the Medicaid agency was not required to obtain them directly from the bank. The court determined that the Medicaid agency "reasonably assisted C.F.J. in completing her application by identifying the bank statements required and by asking that she provide them."

For the full text of this decision, go to: https://www.njcourts.gov/attorneys/assets/opinions/appellate/unpublished/a4385-16.pdf

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