Medicaid Application Denied Because Nursing Home Did Not Have Access to Applicant’s Financial Information

A New Jersey appeals court rules that the state properly denied a Medicaid application that did not include all the necessary information even though the nursing home pursuing the application lacked access to that information. R.P. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-3451-17, April 26, 2021).

R.P. entered a nursing home and applied for Medicaid. The nursing home’s Medicaid coordinator, Janell Thomas, was named as R.P.’s designated authorized representative. The Medicaid agency requested additional information relating to R.P.’s bank and retirement accounts. Ms. Thomas told the agency that she was unable to get the information because she was not R.P.’s agent under a power of attorney and R.P. did not have a guardian. The nursing home filed to appoint a guardian, but R.P. died while the case was pending. The state granted extensions to allow the nursing home to obtain the necessary information, but the Medicaid agency eventually denied the Medicaid application for failure to provide the information.

When the nursing home appealed, the state affirmed the denial of benefits, finding that there was no evidence that the nursing home attempted to collect the information. The nursing home appealed to court.

The New Jersey Superior Court, Appellate Division, affirms, holding that it “was not arbitrary, capricious or unreasonable” for the state “to deny an application that did not have the information necessary to verify eligibility after giving several extensions.” The court noted that the state granted two extensions after R.P. died to allow the nursing home to obtain an administrator for R.P.’s estate, but the nursing home did not pursue the administration until nearly 90 days after R.P. died.

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