In A.M. v. Monmouth County Board of Social Services, which was decided on March 11, 2021, the Superior Court of New Jersey (Appellate Division) reversed the final decision of the Monmouth County Board of Social Services, imposing a 1,170 day Medicaid transfer penalty.
Petitioner, on behalf of his mother, M.M. appealed the final agency decision of the Division of Medical Assistance and Health Services, which found M.M. eligible for Medicaid benefits but imposed a nearly $500,000 penalty, the value of the one-third interest in her home that she had transferred to petitioner during the five-year look-back period, and directed that the penalty be increased by the value of a life estate in the home M.M. had relinquished to her son at the time of transfer. On appeal, petitioner argued that the transfers were exempt from penalty under the statutory child caregiver exemption.
The court agreed with petitioner and reversed the final agency decision imposing a penalty on M.M. which made her ineligible for Medicaid benefits for 1,170 days. The court noted that transfers of interests in a primary residence could be exempt from Medicaid penalties when the transfer is made to a Medicaid applicant’s child under certain circumstances, including when a child was residing in the applicant’s home for at least two years before the applicant became institutionalized and had provided care to the applicant to enable them to continue residing in their home.
The court held that the county welfare agency misapplied the child caregiver exception statute to deny an exception to M.M. The court found that the record clearly supported a finding that petitioner had lived in M.M.’s home for at least two years prior to M.M.’s institutionalization for Alzheimer’s disease, which constituted a condition requiring special care and attention. Specifically, the court ruled that the county welfare agency erred in considering that petitioner worked outside the home as a schoolteacher. The court further found that petitioner provided specialized care including feeding, cleaning, dressing, and medicating M.M. and monitoring during overnight hours. The court also held that petitioner’s arranging for home health services did not automatically render the child caregiver exception inapplicable, as home aides were employed to care for M.M. while petitioner was at work.