Feb 8

Medicaid Applicant Entitled to Additional Time to Provide Documentation


An administrative law judge in New Jersey rules that a disabled Medicaid applicant is entitled to additional time to provide documentation to support his application and that the Medicaid agency is required to assist him. R.P. v. Division of Medical Assistance (N.J. Office of Administrative Law, No. HMA 3127-15, Jan. 15, 2016).

R.P. entered a nursing home and applied for Medicaid benefits. Due to a dementia diagnosis, R.P. was unable to assist with the Medicaid application. The state denied the application for failure to provide required documentation.

R.P. filed a second application. The state denied the application again for the same reason, and R.P. appealed, requesting a hearing. R.P.’s attorney claimed that she attempted to obtain the necessary information, but that it was difficult without R.P.’s assistance. She argued R.P. needed additional time.

The administrative law judge (ALJ) rules that R.P. was entitled to additional time to provide the necessary information for the application. According to the ALJ, the regulation requiring applications to be filed in a timely manner was “not intended to be a tool to administratively or procedurally dismiss applications for disabled applicants.” The ALJ also rules that the Medicaid agency should assist R.P. in acquiring the necessary documents.

For the full text of this decision, click here

For a summary of the ruling by New Jersey ElderLawAnswers member attorney Donald D. Vanarelli, click here.