Medicaid Agency Must Hold Hearing on Nursing Home's Standing to Challenge Resident's Eligibility Determination

A New Jersey appeals court rules that a Medicaid agency cannot refuse a hearing on Medicaid eligibility to a nursing home that was the designated representative of an applicant who died before the agency decided on his application. J.G. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-3643-17T4, May 13, 2019).

J.G. entered a nursing home and named the facility as his designated authorized representative. The nursing home applied for Medicaid on J.G.’s behalf, but he died before the Medicaid agency rendered a decision. The agency denied his application, concluding that he was ineligible because he died before a determination could be made.

The nursing home requested a hearing, but the Medicaid agency denied the request, arguing that J.G.'s estate needed to authorize a representative. The nursing home appealed on behalf of J.G.

The New Jersey Superior Court, Appellate Division, remands the case to the Medicaid agency to determine if the nursing home has standing to bring the case on J.G.'s behalf. The court rules that a hearing will allow the Medicaid agency to determine if the nursing home has standing and if not, whether the estate can identify a new representative.

For the full text of this decision, go to:

Did you know that the ElderLawAnswers database now contains summaries of more than 2,000 fully searchable elder law decisions dating back to 1993? To search the database, click here.