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

Decision and Order


In this case, the applicant’s Medicaid eligibility plan involved making a loan to a relative. The borrowing relative signed a promissory note agreeing to repay the note in monthly installments, including interest. The note and underlying loan were bona fide under NJ law. Unfortunately, the state Medicaid agency considered the loan and note to be a gift, resulting in the applicant being incorrectly charged for a penalty period under the Medicaid transfer of resources rules for many months, costing hundreds of thousands of additional dollars to privately pay for care during the penalty period. Most troubling was the reason for the agency’s determination. According to the agency, the loan was determined to be a gift because the loan was made in order to qualify for Medicaid and, under the agency’s incorrect view of the Medicaid law in New Jersey, motivation for making the loan was the principal factor in determining Medicaid eligibility. I filed an appeal of the denial of Medicaid eligibility, and filed a motion for summary judgment on the Medicaid applicant’s behalf, asking that the case be resolved before trial. A summary judgment motion can be granted only when there is no dispute as to the facts in the case, and the party seeking summary judgment is entitled to a decision in his favor as a matter of law. In this case, the administrative law judge agreed with our position, and granted summary judgment in favor of the Medicaid applicant. The judge held that (1) the motivation for the loan was irrelevant in determining the status of the loan, and (2) the loan was not a gift under federal law. The result of the ALJ’s decision would be that the Medicaid applicant was eligible for nursing home Medicaid benefits. The Director of Medicaid affirmed the decision.

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Reference Info:Decision | State, 3rd Circuit, New Jersey | United States

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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