Medicaid Applicant Not Entitled to Nursing Home Benefits Under Program That Changed Coverage While Application Was Pending

A New Jersey appeals court rules that a Medicaid applicant is not eligible for nursing home benefits under a special state program because the state changed the program stopped covering nursing home services after the applicant applied. M.P. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-5024-16T2, Dec. 17, 2018).

In October 2014, nursing home resident M.P. applied for Medicaid under a special program that had a higher resource cap than regular Medicaid. In December 2014, the state changed the special program to no longer cover nursing facility services and required nursing home residents with excess income to establish a qualified income trust instead. There was an exception for people who were receiving nursing home services before December 1, 2014. M.P.'s assets were above the resource cap until 2015. The state denied his application in 2016.

M.P. appealed the denial of benefits. The state found that M.P. was not entitled to benefits under the program because by the time he had spent down his assets, the program no longer covered nursing home services. M.P. appealed, arguing that he should be grandfathered in to the program because he applied before the law changed.

The New Jersey Superior Court, Appellate Division, affirms, holding that M.P. is not eligible for benefits because the state made clear that unless a person was receiving Medicaid under the special program by December 1, 2014, the state would no longer offer reimbursement for nursing home expenses. According to the court, the state was correct "in denying eligibility to M.P. after December 1, 2014, because he was not receiving Medicaid benefits at that time and the program was no longer available for these type of expenses."

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