The New Jersey Appellate Division affirmed a denial of a nursing home resident’s Medicaid application, ruling that the county agency had properly denied the application when the
applicant’s authorized representative failed to provide requested bank account verifications after omitting three financial accounts from the application. The court rejected the applicant’s arguments that the agency had failed to specifically identify the deficiency, that the self-attestation barred a look-back review, or that the agency was required to grant an extension. H.R. v. Atlantic County Department of Family and Community Development, No. A-3892-24 (N.J. Super. Ct. App. Div. Oct. 5, 2026) (unpublished).
In June 2024, a designated authorized representative (DAR) at H.R.’s nursing facility filed an application on H.R.’s behalf for New Jersey Family Care Aged, Blind, and Disabled Medicaid benefits, attesting that H.R. had no income, assets, or bank accounts. The Atlantic County Department of Family and Community Development (ACDFCD) ran an electronic asset search that revealed two undisclosed Bank of America accounts. The ACDFCD issued a request for information (RFI) seeking statements for the accounts, copies of all checks and nonelectronic deposits of more than $500, and a corrected self-attestation form. The DAR provided the corrected attestation and most of the documents but did not provide the Bank of America statements. The ACDFCD issued a second RFI with an August 12, 2024, deadline. On that date, the DAR provided statements for only one account, which showed transfers totaling $31,834 from a Vanguard account during a three-month period in 2021, which was within the 60-month look-back period. The DAR also asked for more time to obtain the transaction records, stating that she was trying to obtain them but had not yet succeeded.
The ACDFCD denied the application for failure to provide the requested information in a timely manner, and the DAR requested a hearing. An administrative law judge (ALJ) heard testimony from the DAR and an ACDFCD supervisor. The ACDFCD supervisor testified that the agency did not learn of the Vanguard account until April 2025, after it had denied H.R.’s application; she stated that extensions are granted on a case-by-case basis only for extenuating circumstances and that no circumstances justifying further extension of time existed in the present case. The DAR testified that she had not disclosed the accounts because of a language barrier with H.R.’s guardian, who had not provided her with any financial information. The ALJ affirmed the denial, finding that verification of the accounts was necessary to process the application, that the DAR was on notice of the requirement, and that the inaccurate self-attestation did not preclude the ACDFCD from requiring additional information. The ALJ noted that the applicable regulations required the ACDFCD to process H.R.’s Medicaid application within a specified time period and found that the DAR had not identified any extenuating circumstances warranting an extension. The Division of Medical Assistance and Health Services (Division) adopted the decision, and H.R. appealed.
On appeal, H.R. argued that the processing period set forth in the applicable regulation was designed to protect applicants from unwarranted obstructions in their medical coverage, but that the ACDFCD had improperly used it as an arbitrary deadline against her, an applicant making good-faith efforts to cooperate. She also argued that the ACDFCD had failed to communicate with her as required by the applicable regulations because it had never made a specific request for Vanguard-related verification; she argued that, under 42 C.F.R. § 435.907(e)(1), the ACDFCD did not have the authority to demand five-year look-back documentation because she had submitted a proper self-attestation.
The Appellate Division noted that it reviews agency decisions to determine whether an action was arbitrary, capricious, or unreasonable and that the party challenging the decision bears the burden to make such a showing. The court explained that applicants who transfer resources for less than fair market value during a 60-month look-back period before becoming institutionalized or applying for Medicaid are penalized and that such transfers are presumed to have been made to obtain Medicaid eligibility. County welfare agencies must also process applications within set timeframes and may extend those periods only for exceptional reasons. Thus, if an applicant fails to timely provide verification of the value of their resources, then without an extension, the agency may determine that eligibility cannot be established and deny the application.
The court affirmed the Division’s decision, finding that the record fully supported the ALJ’s factual findings and that the legal conclusions were consistent with the law. The court found that the ACDFCD did not deny the application based on a newly identified deficiency raised only after H.R. had responded. Rather, both its RFIs expressly required verification of all checks and deposits over $500 to show the source of the funds; therefore, the Vanguard deposits fell within the scope of the existing requests and a separate Vanguard-specific RFI was not required. The court also found that the ACDFCD had not failed to communicate with H.R.; the DAR’s own statements showed that she understood that additional verification remained outstanding. H.R.’s application was denied because verification had not been provided, not because of a lack of communication.
Although the court acknowledged that an attestation may, in certain circumstances, permit approval without a full look-back, it held that this was not such a case. Because H.R.’s application had omitted two bank accounts that were later revealed by the asset search, and the later-produced documents disclosed more than $31,000 in Vanguard deposits within the look-back period, the ACDFCD was entitled to require further verification and was not bound to accept the attestation. Finally, the court found no error in the ALJ’s conclusion that granting an extension was discretionary and that no extenuating circumstances justified one. Accordingly, the court affirmed the denial.
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