Medicaid Applicant’s Snapshot to Determine Resources Occurred on Pre-Admission Screening Date

Reversing an initial decision, New Jersey’s Medicaid agency determines that an applicant’s snapshot to determine her and her husband’s countable resources occurred on the date of her pre-admission screening, rather than the date her Medicaid application was approved following her institutionalization. S.W. v. Cumberland Country Board of Social Services (N.J. Dept. Human Servs. Div. of Medical Assis. and Health Servs., OAL Dkt. No. HMA 00815-20 (June 4, 2020).

S.W. received a pre-admission screening (PAS) in her home in February 2019 and was found eligible for nursing home benefits. She applied for Medicaid at home in March 2019 and moved to a nursing home in April 2019. The Medicaid agency approved her second application for benefits effective September 1, 2019, pending a spend down of $32,876.85. 

S.W. appealed, arguing that the state should have used the date of the PAS as the snapshot day to determine her and her husband’s countable resources. She argued that if the snapshot had been done on the PAS date, her husband would have been able to keep the maximum amount of resources. Under state regulations, the Medicaid agency must establish the combined countable resources of a couple as of the first period of continuous institutionalization. The office of administrative law determined that the proper snapshot date was September 1, 2019.

The New Jersey Medicaid agency reverses, ruling that the correct snapshot day was the date of the PAS. According to the agency, because S.W. qualified for a Medicaid waiver program that provides benefits at home, the snapshot “does not hinge on” admission to a nursing home, so the “snapshot occurred in February 2019 when she had been determined to be eligible for the level of care provided in a nursing home.”

For the full text of this decision, go to: http://business.cch.com/elr/FADSWvCumberlandCountyBOSS(3)_0820.pdf
 
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