H.L. v. Division of Medical Assistance and Health Services

CourtNew Jersey Superior Court Appellate Division
DecidedNovember 16, 2023
DocketA-2052-21
StatusUnpublished

This text of H.L. v. Division of Medical Assistance and Health Services (H.L. v. Division of Medical Assistance and Health Services) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
H.L. v. Division of Medical Assistance and Health Services, (N.J. Ct. App. 2023).

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-2052-21

H.L.,

Petitioner-Appellant,

v.

DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES and MONMOUTH COUNTY DIVISION OF SOCIAL SERVICES,

Respondents-Respondents.

Submitted October 23, 2023 – Decided November 16, 2023

Before Judges Mawla and Marczyk.

On appeal from the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

Michael Heinemann, attorney for appellant.

Matthew J. Platkin, Attorney General, attorney for respondent New Jersey Department of Human Services, Division of Medical Assistance and Health Services (Melissa H. Raksa, Assistant Attorney General, of counsel; Francis Xavier Baker, Deputy Attorney General, on the brief).

Patrick James Boyle, attorney for respondent Monmouth County Division of Social Services, on the statement in lieu of brief.

PER CURIAM

H.L. appeals from the January 25, 2022 final agency decision of the

Division of Medical Assistance and Health Services ("Division") upholding the

transfer penalty on H.L.'s receipt of Medicaid benefits. In doing so, the

Assistant Commissioner adopted the decision of the Administrative Law Judge

("ALJ"). We affirm.

I.

H.L. was institutionalized at a long-term skilled nursing facility in June

2020. In September 2020, H.L. applied for managed long-term services and

supports ("MLTSS") Medicaid benefits to the Monmouth County Division of

Social Services ("MCDSS"). H.L. included a letter from her son P.L. dated July

15, 2020, stating H.L. lived with P.L. in Connecticut from January 1996, through

January 2020. She continued to live in his home when P.L. moved to Georgia

in January 2020, until June 2020, when she went to a nursing home.

On December 9, 2020, the MCDSS sent a letter to H.L.'s Designated

Authorized Representative for Medicaid purposes, requesting multiple

A-2052-21 2 verifications to determine Medicaid eligibility. On December 24, 2020, the

MCDSS received another letter from P.L. dated July 21, 2020,1 explaining H.L.'s

spending habits. He stated H.L. lived in his house and "paid rent, utilities,

transportation, . . . total[ing] $875[]," and that "she spent the rest as her personal

allowance which was often too little so [he] help[ed] her out."

By correspondence dated January 4, 2021, the MCDSS sent a request for

additional information, asking H.L. to verify sixty transactions 2 made during the

five-year look-back period, from September 2015 to September 2020.

Specifically, the letter stated:

AS THERE COULD POSSIBLY BE A GIFTING PENALTY INVOLVED DUE TO MONIES GIVEN TO [H.L.]'S SON, A FULL LOOK BACK AT HER RESOURCES WAS PERFORMED. PLEASE SEE THE ATTACHED LARGE TRANSACTION LIST. PLEASE VERIFY EACH TRANSACTION. FOR WHICHEVER TRANSACTIONS ARE EXPLAINED BY THE 7/21/20 UNSIGNED LETTER FROM [P.L.], PLEASE PROVIDE A COPY OF ANY RENTAL

1 We assume this letter was misdated as July 21, 2020, and was actually prepared on December 21, 2020, as it was in response to the December 9, 2020 letter from the MCDSS. Moreover, it was stamped received on December 24, 2020. 2 The transactions, totaling $58,000, were cash withdrawals between $700 and $1,800. Most of the funds were between $900 and $1,000 and were primarily withdrawn once per month, but on some occasions multiple withdrawals were made in a single month, and in other months, no cash withdrawals were made. Three $1,000 transactions in 2020—May 7, June 3, and August 7—were direct transfers to H.L.'s son's account. A-2052-21 3 AGREEMENTS SIGNED BY [H.L.] AND HER SON, [P.L.] ANY AGREEMENTS SHOULD HAVE BEEN WRITTEN UP [AND] SIGNED AT THE TIME THEY BEGAN LIVING TOGETHER. PLEASE ALSO PROVIDE ANY CHECKS/BILLS/RECEIPTS TO VERIFY HER LIVING EXPENSES, ETC. PLEASE MAKE SURE ANY WRITTEN ATTESTATIONS ARE SIGNED BY THE ATTESTOR.

On January 14, 2021, H.L. submitted a certification stating she lived with

her son since 1996. H.L. further stated how she would withdraw one large

amount from her bank account each month for all of her daily expenses and that

she gave $875 to P.L. "for rent, and other miscellaneous expenditures for [her]

daily living." Additionally, H.L. attested she "did not give any of [her] funds to

[her] family as a gift and used [her] minimal income for only [her] expenses

monthly." The MCDSS advised in their January 19, 2021 letter that a 162-day

penalty would be imposed related to transfers totaling $58,000 for less than fair

market value during the five-year look-back period.

On February 9, 2021, the MCDSS revised the penalty to 139 days based

on transfers totaling $49,875 to P.L. during the look-back period. The revision

was a result of both H.L. and P.L.'s certifications to the MCDSS that $875 of

the withdrawn funds each month related to rental payments from H.L. to P.L.

Because there was still no verification of a rental or expense agreement, the

MCDSS found the reduced $875 transactions fell under "love and affection."

A-2052-21 4 The MCDSS relied on N.J.A.C. 10:71-4.10(b)(6)(i) for the proposition that

transfers made for "love and affection" are not considered a transfer for fair

market value. The MCDSS reduced each original penalty transaction to the

attested rental amount of $875. 3 The MCDSS determined the excess amount of

each $875 withdrawal was used for H.L.'s living expenses, and this excess

amount was not included in the revised penalty total. Thus, for each transaction,

any amount in excess of $875 was accepted by MCDSS as H.L.'s living expenses

and was not included in H.L.'s total penalty.

In the same February 9, 2021 letter, the MCDSS approved H.L.'s Medicaid

application effective August 1, 2020. However, because of the imposition of

the 139-day penalty, Medicaid would not cover H.L.'s room and board at her

nursing facility from August 1, 2020, to December 18, 2020. H.L. requested an

administrative hearing, and the matter was transmitted to the Office of

Administrative Law.

On October 19, 2021, a hearing was held before an ALJ. An MCDSS

worker testified on its behalf. She explained the MCDSS's application process,

how she reviewed H.L.'s application for benefits, the rationale behind reducing

3 Both H.L. and P.L. initially stated H.L. paid monthly rent in the amount of $875. However, P.L. later certified he did not mean to state that H.L. paid "rent." Rather, he claimed she merely contributed towards "household expenses." A-2052-21 5 the penalty based on the attestations provided by H.L. and P.L., and the

reasoning supporting the 139-day transfer penalty based on H.L.'s failure to

produce a rental agreement or any form of receipts, bills, or invoices

substantiating her living expenses.

H.L. submitted a certification from P.L. dated October 18, 2021, which

stated that "nearly all" of H.L.'s income went towards her share of the household

expenses. P.L. certified he did not have any rental agreement with H.L. because

"we do not charge family members rent but family members, sharing a home,

all contribute towards their share of the household expenses." Neither H.L. nor

P.L. testified at the hearing.

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