Recurring Scam Withdrawals Result in Medicaid Application Denial

A New Jersey appeals court has ruled that the Medicaid agency properly denied an application on the basis of the applicant failing to "verify" recurring transactions on the applicant’s bank statement even though the transactions may have been part of a scam.  G.M. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., App. Div., No. A-0433-19, June 16, 2021).

G.M. suffered from dementia and lived in a nursing home. In 2018, she applied for Medicaid benefits and submitted the required bank statements. The Medicaid agency requested verification of recurring transactions from 2013 in the amount of $300 that were labelled:

"ACH DEPOSIT UNITEDCAPITALCRE UNITED CAP" (UCC)." 

G.M.’s authorized representative stated that her family believed the transactions were part of a scam of which G.M. was a victim.  The representative provided supporting "screenshots" to show that the company UCC was no longer in business.  As a result of the foregoing, the representative declared that she could not provide formal documentation.

The Medicaid agency denied G.M.’s application for failing to provide sufficient verifications. G.M. appealed, but the administrative law judge affirmed the denial, stating that there was a lack of evidence that G.M.’s agent under her power of attorney attempted to determine the nature of the transactions. The Medicaid agency affirmed the denial, and G.M. appealed to court.

The New Jersey Superior Court, Appellate Division, affirmed, holding that the Medicaid agency properly denied G.M.’s Medicaid application for failure to provide verifications. According to the court, the screenshots of UCC’s former website did not provide evidence of the purpose of the transactions, so G.M.’s “proof of eligibility was inconclusive."  The "decision to deny [G.M.’s] application was not arbitrary, capricious, or unreasonable.”

The decision does not address what, in addition to the representative's declaration, would suffice.