Many Medicaid applications in New Jersey are denied by the County Board of Social Services for failure to produce documents. It is often difficult to obtain voluminous financial records covering the five year look-back period. Based upon recent revisions that have been made to our Medicaid laws, we are now permitted to obtain an extension to produce the requested documents.
On May 3, 2022, the New Jersey Division of Medical Assistance and Health Services (“DMAHS”) issued a directive to all of the Medicaid agencies in the State of New Jersey. This directive is known as Medicaid Communication No. 22-04 (“MID Comm. 22-04”). According to MID Comm. 22-04, the County Board of Social Services must give a Medicaid applicant 14 days to respond to a County’s request for documents. If the request concerns a Renewal Application for Medicaid, then the beneficiary has 30 days to respond to the County’s request for documents.
Pursuant to MID Comm. 22-04, it is understood that exceptional circumstances may arise in the process of determining Medicaid eligibility. MID Comm. 22-04 provides that if a Medicaid applicant or beneficiary requests additional time to provide information and “continues to cooperate in good faith”, then a “reasonable extension of time” may be permitted.
MID Comm. 22-04 sets forth that if a Medicaid application is denied for failure to provide documents, then “no further documentation will be accepted” by the Medicaid agency. If a Renewal Application, however, is denied for failure to produce documents, then that beneficiary has the right to provide the documents within 90 days of the denial. According to MID Comm. 22-04, “reconsideration is required if the information is returned within 90 days of the termination date”. MID Comm. 22-04 further provides that a new Medicaid application may not be requested by the County Board of Social Services.