Medicaid Applicant Who Did Not Appeal a Determination Cannot File Another Application

A New Jersey appeals court rules that the state properly refused to consider a new Medicaid application from a woman who already had a previous Medicaid application approved subject to a transfer penalty and who missed the deadline to appeal. R.M. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-3079-19, July 29, 2021).

R.M. applied for Medicaid benefits three times in 2018. The state denied the applications because she did not provide requested financial verifications. She appealed the third denial and supplied additional information. On June 6, 2019, the state granted her application subject to a transfer penalty, finding she transferred $688,418.98 in assets for less than fair market value. R.M. did not appeal the decision. Instead, she filed a new application on July 30, 2019.

The state refused to process her July 30th application, stating that its original June 6th determination still stood. R.M. sought a fair hearing, but the state denied her request because it came 120 days after the June 6th determination, so it was untimely. R.M. appealed to court, arguing that the state should have issued a determination on her July 30thapplication and granted her a fair hearing.

The New Jersey Superior Court, Appellate Division, affirms holding that the state properly refused to consider R.M.’s July 30th application. The court rules that she missed her opportunity to address the penalty and pursue a fair hearing on the June 6th determination, so “R.M.'s July 30 application appears to be her attempt to restart the clock, and she has made no showing that the [state] in any way failed to follow the law or was arbitrary, capricious, or unreasonable.”

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